拇指第一腕掌关节桡背侧脱位的解剖学及相关力学研究

发布时间：2018-11-22 08:36

【摘要】： 目的研究拇指第一腕掌关节周围韧带的走行、毗邻、形态及结构特点,探讨拇指第一腕掌关节桡背侧脱位的解剖学基础,为临床诊断和处理提供解剖学依据。方法 12例国人成年男性尸体手作为解剖标本,经X线平片检测每一标本都不存在解剖变异,骨性关节炎表现。对于随机、性别和优势手上的差异没有予以考虑。分别从拇指腕掌关节的背侧和掌侧仔细地切除皮肤,皮下组织,切除大鱼际肌,显露关节囊,在解剖韧带之前全面观察关节囊。在2.5倍手术放大镜下进行解剖观察,观察了拇指第一腕掌关节周围5条韧带的走行、比邻和形态结构特点,研究了构成第一腕掌关节骨的形态学特点,用游标卡尺(精确度为0.01mm)测量各组韧带在正常(中立位)状态下的长度(韧带的起止点间的距离)及最大拉伸长度,取每条韧带的中点测量其宽度和厚度在最大屈曲位,背伸位、内收位、外展位状态下,用游标卡尺测量韧带的长度。所得的数据进行统计学处理(以(?)±S)。对后斜韧带及桡背侧韧带的相关力学进行了测量。结果拇指第一腕掌关节的韧带组成复杂,其周围韧带的构成有以下五种即:前斜韧带、后斜韧带、桡背侧韧带、尺侧副韧带与第一掌骨间韧带。观察五组韧带,关节背侧韧带较为肥厚,粗大。比较背斜韧带与桡背侧韧带的力学时发现:桡背侧韧带与后斜韧带在稳定拇指第一腕掌关节背侧作用无明显的差异,但桡背侧韧带在稳定拇指第一腕掌关节桡侧作用大于后斜韧带。结论拇指第一腕掌关节周围的韧带中,背侧韧带厚而紧张。桡背侧韧带在阻止拇指第一腕掌关节桡背侧脱位的作用要强于后斜韧带。在临床工作中应注重桡背侧韧带的修复。
[Abstract]:Objective to explore the anatomic basis of the first metacarpophalangeal joint of the thumb in the radial dorsal dislocation of the first metacarpal joint of the thumb, and to provide anatomic basis for clinical diagnosis and management. Methods 12 Chinese adult male cadavers were taken as anatomical specimens. No anatomic variation was found in each specimen by X ray plain film, and osteoarthritis was found. Random, gender and dominance differences were not taken into account. The skin and subcutaneous tissue were excised from the dorsal and palmar sides of the metacarpophalangeal joint of the thumb respectively. The hypothenar muscles were excised and the articular capsule was exposed. The articular capsule was observed before anatomic ligaments. Anatomic observation was carried out under a 2.5 times operating magnifying glass. The running, adjacent and morphological characteristics of the five ligaments around the first metacarpal joint of the thumb were observed, and the morphological characteristics of the bone forming the first carpometacarpal joint were studied. Vernier caliper (accuracy of 0.01mm) was used to measure the length of the ligaments in normal (neutral position) state (the distance between the starting and ending points of the ligaments) and the maximum stretch length. The width and thickness of the ligaments were measured at the maximum flexion position at the midpoint of each ligament. Measure the length of ligaments with Vernier calipers in the position of extension, adduction, and display. The obtained data were statistically processed (in the form of (?) 卤S). The mechanics of posterior oblique ligament and dorsal radial ligament were measured. Results the ligaments of the first carpometacarpal joint of the thumb were complicated, and there were five kinds of ligaments around them: anterior oblique ligament, posterior oblique ligament, dorsal radial ligament, ulnar collateral ligament and first metacarpal ligament. Observation of the five groups of ligaments, joint dorsal ligament is thicker, thicker. When comparing the mechanics of the anticlinal ligament with the dorsal radial ligament, it was found that there was no significant difference between the radial dorsal ligament and the posterior oblique ligament in stabilizing the dorsal side of the first metacarpal joint of the thumb. But the radial dorsal ligament was more effective in stabilizing the first carpometacarpal joint of the thumb than the posterior oblique ligament. Conclusion in the ligaments around the first metacarpal joint of the thumb, the dorsal ligament is thick and tense. The radial dorsal ligament is stronger than the posterior oblique ligament in preventing the first metacarpal joint of the thumb. Attention should be paid to the repair of dorsal radial ligament in clinical work.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R684;R322;R318.01

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