三角纤维软骨复合体解剖及生物力学研究

目的从解剖完整的腕关节入手,阐明三角纤维软骨复合体各组成部分的解剖特点,评估三角纤维软骨复合体(TFCC)对于维持远侧桡尺关节稳定的重要性。方法对8个新鲜解冻的腕关节和6个经甲醛浸泡的腕关节进行显微解剖。同时对影响远侧桡尺关节稳定性的因素作了初步的评估。前臂中旋位,垂直于尺骨予20N拉力下测量尺骨相对于桡骨的位移,然后先后切断掌背侧桡尺韧带,测量尺骨相对于桡骨的位移变化。结果发现掌背桡尺韧带由三角纤维软骨盘外周增厚而成,止于尺骨茎突基底部,是维持远侧桡尺关节稳定性的主要因素之一,切断掌背侧桡尺韧带会导致远侧桡尺关节明显不稳。结论TFCC由三角纤维软骨盘、掌背侧桡尺韧带、尺骨月骨韧带、尺骨三角骨韧带、尺侧腕伸肌下腱鞘、半月板同源物、尺侧囊组成。掌背桡尺韧带是维持远侧桡尺关节稳定性的主要因素之一,掌背侧桡尺韧带损伤会导致远侧桡尺关节明显不稳。

Anatomical and biomechanical study of the triangular fibrocartilage complex(TFCC)

Objective:To describe the anatomic structure and characteristic of the component of the triangular fibrocartilage complex (TFCC) and evaluate the importance of the TFCC in maintaining the stability of the distal radioulnar joint (DRUJ).Methods:Eight fresh-frozen and six embalmed cadaver upper extremities were used for anatomic study of the wrist joints.At the same time,the factors maintaining the stability of the DRUJ were evaluated.The displacement of the distal ulna with respect to the radius was measured while a controlled 20 N force was applied in both the palmar and dorsal direction perpendicular to long axis of the radius in neutral position.First,the dorsal radioulnar ligament (D-RUL) were excised,then the palmar radioulnar ligament (P-RUL) were excised.Results:The palmar-dorsal radioulnar ligaments (P-DRULs) were the thickening part of the peripheral portion of the articular disc of the TFCC.Excision of the P-DRULs led to significant instability of the DRUJ.Conclusion:The triangular fibrocartilage complex (TFCC) of the DRUJ consists of the articular disc,the meniscus homologue,the palmar and dorsal distal radioulnar ligaments,the subsheath of extensor carpiulnaris,the ulnotriquetral and the ulnolunate ligaments,and the ulnar capsule.P-DRULs is one of the most important factors maintaining DRUJs instability.Injury of the P-DRULs led to significant instability of the DRUJ.