腕关节镜掌侧入路安全区的临床解剖学研究

目的 解剖观察与腕关节镜掌侧入路建立相关的腕部结构,探索建立入路的安全区域.方法采用8例防腐标本和2例新鲜标本,模拟手术“由内向外”操作,标识掌侧入路,测量与掌侧入路建立有关的1/2、6R、6U入路和VR、VR’、VU入路与周围重要结构的最近距离.结果 1/2入路与桡神经浅支的最近距离是( 2.4± 1.5 )mm.6U、6R入路与尺神经腕背支的最近距离是(16.2±1.3 )mm和(9.0±2.4)mm.VR、VR’入路与正中神经掌皮支的最近距离是(6.7±1.1)mm和(2.8±0.9 )mm,与桡动脉的最近距离是( 6.3±4.0 )mm和(10.0±3.4 )mm,并且均穿过桡侧腕屈肌腱的基底部.VU入路与尺动脉和指深屈肌腱的最近距离是(3.3±1.4)mm和( 0.3±0.5 )mm.结论 腕关节镜掌侧入路的建立有一定的安全区域.     

腕关节镜术入路有关的应用解剖

为促进腕关节镜术在我国的开展，采用福尔马林固定的成人手标本５只，骨肿瘤截肢的成人手标本５只，对与关节镜术有关的大体及关节镜下解剖进行观察，文章详尽描述了９个关节镜学用入路的位置及毗邻关系，关节囊韧和三角纤维软骨复合体的附着点和形态特征，各入路的可视范围及关节囊内诸结构的镜下解剖特征，同时对各入路的安全性和实用性进行了详细的讨论。     

腕关节镜术入路有关的应用解剖

为促进腕关节镜术在我国的开展,采用福尔马林固定的成人手标本5只,骨肿瘤截肢的成人手标本5只,对与关节镜术有关的大体及关节镜下解剖进行了观察。文章详尽描述了9个关节镜常用入路的位置及毗邻关系、关节囊韧带和三角纤维软骨复合体的附着点和形态特征、各入路的可视范围及关节囊内诸结构的镜下解剖特征,同时对各入路的安全性和实用性进行了详细的讨论。     

不同入路方式下锁定钢板内固定治疗桡骨远端骨折的疗效及对腕关节功能的影响

目的探究掌侧与背侧两种入路方式锁定钢板内固定术治疗桡骨远端骨折的疗效以及对患者术后腕关节功能的影响。方法选择本院2018年1月至2019年1月收治的50例行锁定钢板内固定治疗的桡骨远端骨折患者作为研究对象,根据入路方式的不同将其分为掌侧组(28例)和背侧组(22例)。比较两组患者的手术时间、术中出血量、愈合时间、手术后尺偏角、掌倾角及挠骨高度和术后3个月腕关节功能改善情况及术后并发症发生率。结果掌侧组患者手术时间显著短于背侧组,差异具有统计学意义(P0.05);掌侧组患者术后3个月总并发症发生率显著低于背侧组,差异具有统计学意义(P0.05);两组患者术中出血量、骨折愈合时间、术后尺偏角、掌倾角及挠骨高度及3个月后腕关节功能优良率比较,差异均不具有统计学意义(P0.05)。结论两种入路方式下锁定钢板内固定术治疗桡骨远端骨折患者的效果相当,均比较理想,对腕关节的功能影响差异不大,但掌侧入路锁定钢板内固定术手术时间更短,术后并发症发生率更低。     

腕掌侧双通道改良手术入路治疗桡尺骨远端骨折的解剖学基础

目的　报道腕掌侧双通道入路治疗桡尺骨远端骨折的应用解剖学基础。 方法 10侧新鲜成人尸体上肢标本,于腕掌侧在桡侧腕屈肌腱与掌长肌腱之间做纵行切口,进入皮下后向桡侧、尺侧绕过腕管内结构,通过双通道入路来观测桡骨、尺骨远端的暴露情况。 结果 在腕横纹上方3.0 cm水平,桡侧通路牵拉最大横向暴露距离为(3.0±0.29) cm,尺侧通路牵拉最大横向暴露距离为(2.3±0.26) cm,桡侧通路暴露桡骨远端尺侧半效果欠佳,而尺侧通路可以有效暴露桡骨远端尺侧半及尺骨远端。 结论 腕掌侧双通道改良手术入路治疗桡尺骨远端骨折具有可行性,暴露效果良好,值得在临床上推广。     

腕桡侧入路掌侧锁定钢板内固定治疗桡骨远端骨折的效果

目的 探讨腕桡侧入路掌侧锁定钢板内固定对桡骨远端骨折患者术中出血量及腕关节功能的影响。方法 选取2016年8月~2019年8月我院收治的80例桡骨远端骨折患者,随机分为对照组及观察组,各40例,对照组予以腕桡侧入路掌侧普通钢板内固定治疗,观察组予以腕桡侧入路掌侧锁定钢板内固定治疗,比较两组手术时间、术中出血量、住院时间、骨折愈合时间及术前、术后3个月疼痛程度和腕关节功能。结果 两组手术时间、术中出血量及住院时间比较,差异无统计学意义（P＞0.05）;观察组骨折愈合时间短于对照组,差异有统计学意义（P＜0.05）;两组术前VAS评分、PRWE评分以及Gartland-Werley评分比较,差异无统计学意义（P＞0.05）;术后3个月两组VAS评分、Gartland-Werley评分下降,PRWE评分上升,且观察组改善优于对照组,差异有统计学意义（P＜0.05）。结论 腕桡侧入路掌侧锁定钢板内固定治疗桡骨远端骨折效果确切,有助于缩短骨折延迟愈合时间、减轻患者疼痛,改善患者腕关节功能。     

桡侧腕长伸肌腱部分移位修复第一腕掌关节脱位的解剖与临床

目的：为第一腕掌关节脱位修复提供术式设计的解剖学依据。方法：30侧成人上肢标本，对桡侧腕长伸肌腱进行形态学测量。结果：桡侧腕长伸肌腱性部分长17.8±2.6cm，肌腱上、中、下段宽分别为13.7±3.1mm，5.6±1.1mm和4.6±0.5mm，肌腱上、中、下段厚分别为1.5±0.5mm、2.0±0.3mm和2.4±0.3mm。结论：桡侧腕腕长伸肌部分肌腱转位，有足够的长度和强度修复第一腕掌关节脱位，术式设计合理，是一种新的手术方法，临床应用3例，获得良好效果。     

桡侧腕掌屈肌伴掌长肌副腱一例

在制作一成年男性右上肢标本时,见桡侧腕短屈肌伴掌长肌副腱一例。此变异罕见,为积累国人解剖学数值资料,现报道如下。     

拇指腕掌关节周围韧带的解剖学分析

目的　解剖拇指腕掌关节周围各条韧带及观察其组织形态学特征,探讨其在拇指腕掌关节稳定性中的作用。 方法　采用大体解剖学方法对10例新鲜冰冻手标本进行解剖,识别拇指腕掌关节周围韧带的连接部位与方向性,对韧带的宽度、长度、厚度进行形态学对比分析。并组织学观察拇指腕掌关节背侧和掌侧韧带细胞数。 结果　确定拇指腕掌关节周围存在7条主要韧带：即由3条背侧韧带（桡背侧韧带、背侧中央韧带、后斜韧带）组成的复合体,厚度分别为(1.24±0.12)、(1.91±0.15)、(1.61±0.12) mm。2条掌侧韧带（前斜韧带、尺侧副韧带）,厚度分别为(0.78±0.11) mm、 (1.03±0.11) mm。2条尺侧韧带（大多角骨-第1掌骨背侧韧带,第1、2掌骨间韧带）,厚度分别为(0.78±0.19) mm、(0.89±0.19) mm。背侧韧带明显厚于掌侧韧带（P<0.01）,桡背侧韧带、背侧中央韧带、后斜韧带的细胞数多于前斜韧带,后斜韧带的细胞数也多于尺侧副韧带,均有统计学差异（P<0.05）。 结论　3条背侧韧带组成粗厚坚韧的复合体,在拇指腕掌关节的稳定中,前斜韧带起着更大的作用。     

Anatomical and safety considerations in establishing portals used for wrist arthroscopy

Eight portals are used for wrist arthroscopy, five for the radiocarpal joint and three for the midcarpal space. These portals pass between important vessels and cutaneous nerves and the extensor tendons underlying the extensor retinaculum and permit access to the common pathologies of the wrist joints. The portals can be safely established making precise use of the external landmarks and are associated with little soft tissue damage and few complications when performed gently and through the dorsal side of the wrist. Clin. Anat. 12:179–185, 1999. © 1999 Wiley‐Liss, Inc.     

Anatomical relationship between the morphology of the styloid process of the ulna and the attachment of the radioulnar ligaments

The radioulnar ligaments are the major stabilizers of the distal radioulnar joint under dynamic loading; however, anatomical detail regarding their attachment on the middle and distal thirds of the styloid process of the ulna remains unclear. Because previous anatomical studies included only old cadavers, their anatomical findings might not reflect the morphological features of younger and healthy specimens. This study investigated the anatomical features of the distal ulna, particularly the styloid process, to determine the attachment of the radioulnar ligaments to the styloid process and verified their direction and attachment to the styloid process in younger and healthy donors using magnetic resonance imaging (MRI). We investigated the morphological features of the distal ulna of 12 cadaveric wrists using micro-computed tomography (micro-CT). We also visualized and measured the distribution of the cortical bone thickness. We histologically analyzed three specimens in the axial plane and macroscopically analyzed seven specimens to examine the attachment of the radioulnar ligaments to the styloid process. In addition, we evaluated five wrists from living volunteers using 3.0 Tesla MRI. The distal ulna has a ridge on the dorsoradial aspect of the styloid process that corresponds to the attachment of the radioulnar ligaments. Micro-CT images after data processing revealed that the cortical thickness of the dorsoradial quadrant was thicker than that of the other quadrant at the proximal slice of the styloid process (p < 0.01), and that of the dorsoulnar (p = 0.021) and ulnopalmar (p < 0.01) quadrants at the middle slice. Histological analyses showed that the radioulnar ligaments were attached to the middle and distal thirds of the styloid process via chondral-apophyseal entheses. The direction of the fiber was dorsal in the middle third of the styloid process and changed to palmar in the distal third of the styloid process. The direction and attachment of the radioulnar ligaments on the styloid process were confirmed using MRI for younger and healthy participants. The radioulnar ligaments were attached to the dorsoradial ridge of the styloid process, which was confirmed by cortical bone thickening, histology at the attachment sites, and in vivo MR imaging. The directions of the radioulnar ligaments sterically intersected, which would satisfy both slipping stability and rotational mobility. These anatomical findings may provide the basis for biomechanical consideration of distal radioulnar joint stabilization.     

Histological anatomy of the triangular fibrocartilage complex of the human wrist

The triangular fibrocartilage complex (TFCC) was studied in serial histological sections of the human wrist to reveal its three-dimensional fine structure. The TFCC consisted of a fibrocartilaginous disc proper and other fibrous components. Three-dimensionally, the distal portion of the TFCC had a hammock-like contour that partially surrounded the carpus; while the proximal ligamentous portion corresponding to the radioulnar ligament connected the radius to the ulna. The radioulnar ligament originated at the ulna from both the fovea and the basistyloid. The fibres first gathered and then bifurcated palmarly and dorsally, enclosing and partially coalescing with the proximal side of the disc before inserting around the distal rim of the sigmoid notch of the radius. The meniscus homologue, which corresponded to the ulnar internal wall of the wrist joint, was derived from a loose synovial fold adapting to the stresses from radioulnar deviation. The distal side of the disc consisted of a dense population of chondrocytes in a collagen matrix, while the proximal side was rather rich in fibres directed radioulnarly. Inside the TFCC were loose connective tissues. The histological arrangement of the TFCC is compatible with its function of supporting the carpus, stabilizing the joints and allowing smooth motion of the wrist.     

桡腕背侧韧带的解剖学研究及临床意义

目的 :研究桡腕背侧 (dorsalradiocarpal,DRC)韧带的形态结构、分布特点及力学特性。 方法 :对76侧成人尸体上肢标本 ,解剖观察DRC韧带的形态特征 ;16侧新鲜标本用来作切片观察DRC韧带的组织结构和进行生物力学测试。结果 :DRC韧带形态有 4种类型 :⑴DRC韧带由单一部分起源于桡骨远端背侧Lister结节前及其尺侧占 3 3 % ( 2 5侧 ) ;⑵DRC韧带由两部分组成 ,起自Lister结节前及其尺侧占3 0 % ( 2 3侧 ) ;⑶DRC韧带由起源于Lister结节及其桡侧的两个部分组成占 17% ( 13侧 ) ;⑷DRC韧带由3部分组成 ,分别起始于Lister结节及其尺、桡侧占 2 0 % ( 15侧 )。DRC韧带主要以粗大纵向排列的胶原纤维组成 ,最大拉伸力是 ( 2 2 7.6± 2 6.2 )N。结论 :⑴DRC韧带存在 4种不同起始类型 ;⑵该韧带对维持腕关节稳定具有重要作用 ,应重视DRC韧带损伤的修复。     

Innervation of the triangular fibrocartilage complex of the human wrist: Quantitative immunohistochemical study

The distribution of neural elements in the triangular fibrocartilage complex (TFCC) of the human wrists was studied via immunohistochemical staining of protein gene product (PGP) 9.5 and calcitonin gene-related peptide (CGRP). Articular branches projecting to the TFCC arose from the dorsal branch of the ulnar nerve in all wrists examined. The TFCC is subdivided into the following six regions: the articular disc proper (ADP), meniscus homolog (MH), radio-ulnar ligament (RUL), loose part of ulnar collateral ligament (lUCL), dense part of ulnar collateral ligament (dUCL), and internal portion (IP). The IP consists of a mixture of dense and loose connective tissues enclosed by the ADP, MH, RUL, and UCL, and resides deep in the prestyloid recess, which is a pit in the MH. The densities of PGP 9.5-positive neural elements, including free nerve endings, single nerve fibers, nerve fascicles, and perivascular neural nets, were significantly higher in the IP than in other regions. Some of the neural elements except for the perivascular neural nets were positive for CGRP. The high density of neural elements in the IP suggests that sensory nerves projecting to the TFCC enter into the IP and from there distribute to adjacent regions such as the MH and RUL. Free nerve endings are responsible for pain transmission. The high density of free nerve endings in the IP suggests that the IP is a source of ulnar side wrist pain.     

关节镜辅助下尺骨远端大斜形截骨张力带固定治疗尺骨撞击综合征的近期临床疗效观察

目的 研究关节镜辅助下尺骨远端大斜形截骨张力带固定治疗尺骨撞击综合征的近期临床疗效。方法 回顾性分析2016年1月至2022年4月湖北理工学院附属黄石爱康医院骨科28例关节镜辅助下尺骨远端大斜形截骨张力带固定治疗尺骨撞击综合征的患者资料,均为单侧病变。比较术前和末次随访时的VAS评分、改良Mayo腕关节评分、握力及活动度。结果 术后随访时间为10 ～ 24个月,平均17.5个月。伤口均Ⅰ期愈合,截骨端平均骨愈合时间为8.5周。末次随访时VAS评分、改良Mayo腕关节评分、活动度及握力较术前明显改善,差异有统计学意义（P＜0.05）。结论 关节镜辅助下尺骨远端大斜形截骨张力带固定治疗尺骨撞击综合征的近期临床疗效满意。     

尺动脉腕背支第5掌骨骨膜瓣修复三角纤维软骨的解剖基础

目的：为三角纤维软骨修复提供新的手术方法。方法．在40侧经动脉灌注红色乳胶的成人尸体标本上，解剖观测尺动脉腕背支的走行、分支及分布。结果：尺动脉腕背支在豌豆骨近侧3．9cm处起于尺动脉，分为升支和降支。其中降支为腕背支的延续，大多数(70％)沿第5掌骨尺侧缘径直下行达第5掌骨头、体交界处与小指动脉尺侧支相吻合；少数(30％)降支至豌豆骨附近变为纤细，由小指动脉尺侧支上行与之吻合。降支或小指动脉尺侧支循第5掌骨头尺侧走行时发1～3支、外径0．3～0．7mm骨膜支，分布于第5掌骨背内面骨膜。结论：可以尺动脉腕背支降支为蒂设计第5掌骨骨膜瓣转位修复三角纤维软骨的新术式。     

LARS人工韧带同时重建前、后交叉韧带

目的探讨关节镜下LARS（Ligament Advanced Reinforcement System，LARS）人工韧带同时重建前（An-terior cruciate ligament，ACL）、后交叉韧带（posterior cruciate ligament，PCL）的方法和临床疗效。方法从2006年1月至2007年4月，用LARS人工韧带同时重建ACL、PCL2例。应用Lysholm功能评分表评估膝关节功能，采用抽屉实验检查膝关节前后松弛度。结果2例均获得随访，随访时间分别为8月、3月。2例患者术后患膝关节不稳定症状消失，胫骨后坠征阴性，前、后抽屉试验阴性。膝关节功能评估采用Lysholm功能评分标准，术前平均分别为45．6±7．6分，术后平均为80．3±9．1分。结论关节镜下应用LARS人工韧带同时重建ACL、PCL可更好地恢复膝芙节的稳定性，且创伤小，并发症少，近期疗效满意，但远期效果仍需进一步观察。     

面部组织移位入颅底手术的临床解剖学研究

目的：为面部移位颅底手术入路提供解剖学基础。方法：在３６侧成人头面部标本上，对面神经、腮腺管的位置和层次进行了观察与定位。结果：①面动脉在眶下缘水平至鼻旁间距为９．９±５．０ｍｍ，至骨膜的深距为２．１±０．８ｍｍ；②面神经由茎乳孔出颅后，经腮腺、咬肌和颊区三段分布于面肌。在咬肌段，面神经紧贴咬肌表面行走，面神经颧支行于颧骨表面，至骨面的最小深距为１ｍｍ。结论：①旁正中切口不会影响面动脉；②掀翻面肌皮瓣时，颧骨表面和咬肌表面的面神经分支是易损伤区