双侧拇长展肌变异一例

拇长展肌起自桡骨、尺骨的背面和前臂骨间膜,走行于桡侧腕伸肌、指伸肌的深面和拇短伸肌的上方,在伸肌支持带深层,拇长展肌与拇短伸肌腱走行于同一个纤维鞘中,随后拇长展肌腱向下止于第一掌骨底,拇短伸肌腱止于拇指近节指骨底。我们在局解课上解剖一具男尸时发现一例双侧拇长展肌双肌腹、双肌腱变异。现详细报道如下。1拇长展肌的解剖双侧拇长展肌均于肌腹中下1/3处移行为双肌腹,以双肌腱止于第一掌骨底和大多角骨,分别命名为拇长展肌桡侧腱和拇长展肌尺侧腱。左侧拇长展肌在肌腹中下1/3处移行为双肌腹,拇短伸肌腱与拇长展肌尺侧肌腱共行于…     

示指固有伸肌起自掌背1例

尸体解剖发现 1例左示指固有伸肌起自掌背 ,由于临床常用示指固有伸肌腱移位修复拇长伸肌腱断裂 ,故此变异有一定临床意义 ,报道如下 :成年男性尸体标本 ,左示指固有伸肌腱较对侧细小 ,肌腹长 3ｃｍ ,在腕背侧韧带以远该肌起于第 3掌骨基底 ,腱位于示指伸肌腱内侧走向示指背侧 ,与示指伸肌腱融合为指伸肌腱扩张部 (附图 )。该肌的血供来自腕背动脉弓的分支 ,骨间后神经发出分支至拇长伸肌后 ,于指伸肌腱深面穿腕背第 4骨纤维管以终末支进入该肌。右示指固有伸肌起点正常。标本上模拟手术 ,以起点变异的示指固有伸肌腱移位修复拇长伸肌腱。于…     

拇指伸肌腱宽度与拇短伸肌腱止点关系的研究

目的测量拇指伸肌腱的宽度,并分析该宽度与拇短伸肌腱远端止点之间的关系。方法 76例(左侧39例,右侧37例)经10%福尔马林溶液灌注固定的人体上肢标本,解剖第1骨纤维管、拇长展肌、拇短伸肌以及拇长伸肌,观察纤维管内肌腱中隔分布情况;采用游标卡尺,测量拇指近节指骨背面中点处伸肌腱宽度,利用ROC曲线,分析该宽度与拇短伸肌腱远端止点之间的关系。结果①52例第1骨纤维管内出现肌腱中隔(68.4%);30例拇短伸肌腱止点发生延长,即越过拇指掌指关节;②拇短伸肌腱未延长组,伸肌腱宽度(6.04±0.92)mm;而延长组拇指伸肌腱的宽度(7.52±1.38)mm,显著高于未延长组(t=4.050,P=0.000);③通过测量拇指近节指背中点处伸肌腱宽度,判断拇短伸肌腱止点延长的情况:ROC曲线下面积0.823,临界值7.21 mm,灵敏度和特异度分别是0.843和0.927,正确率为90%。结论当拇短伸肌腱止点延长时,拇指近节指骨背面肌腱的宽度增加;此宽度不仅能够用来识别变异,对于拇指腱鞘炎的外科治疗,具有一定的指导意义。     

桡侧腕伸肌多副腱伴肌腱融合变异一例

<正>在制作一成年男性右上肢标本时,见其桡侧腕长伸肌及桡侧腕短伸肌肌腱分支及融合变异,较罕[1]见,为增加国人解剖学数值,现报道如下。桡侧腕长伸肌起点正常,沿肱桡肌桡侧下行,在距起点92.18mm处分为主肌腹和副肌腹。主肌腹和主肌腱走行及止点正常。副肌腹沿主肌腱向远侧走行143.64mm后移行为长163.50mm,宽4.52mm,厚0.82mm的副肌腱。副肌腱沿主肌腱尺侧贴桡骨体向骨间缘绕行,在拇长展肌与拇短伸肌腱深面绕向背     

拇腕掌关节面立体测量及其意义

目的 :研究拇腕掌关节面的立体几何特征 ,为该关节运动分析提供形态学参数。方法 :用结构光立体测量系统 ,测量成人尸体大多角骨远侧端关节面和第 1掌骨底关节面 ,数据自动采集 ,打印出关节面立体轮廓图、等高线图、断面曲线和曲率曲线图。结果 :拇腕掌关节为鞍状关节 ,大多角骨关节面在桡尺方向上凹 ,在掌背方向上凸 ,第 1掌骨底关节面在桡尺方向上凸 ,在掌骨方向上凹 ,关节面在相互垂直方向上紧密嵌合 ,关节面分为五区 ,中央区及其周围为等曲率区。结论 :结构光测量系统可得到关节面的立体几何特征 ,拇腕掌关节的几何形态是该关节活动形式复杂的结构基础。     

拇短展肌对拇指指骨间关节背伸作用的解剖学研究

目的　为解决胸小肌移植重建拇对掌功能术后出现拇指指骨间关节屈曲畸形提供解剖学依据并寻找解决办法。 方法　在15具尸体手标本上,使拇指处于对掌位时,测量拇指指骨间关节在拇短展肌未切断及切断两种情况下的自然屈曲角度;同时,通过外力作用使拇指指骨间关节分别屈曲处于45°及60°时,分析拇短展肌对拇指指骨间关节屈伸功能的影响。 结果　拇指处于对掌位时,拇短展肌在未切断及切断两种情况下,拇指指骨间关节自然屈曲角度分别为（13.30±2.13）°及（24.03±1.25）°;同时,使拇指指骨间关节屈曲处于45°时,所用外力分别约（0.50±0.08）N及（0.22±0.07）N,而使拇指指骨间关节屈曲处于60°时,所用外力分别约（1.48±0.09）N及（1.15±0.04）N。 结论　拇短展肌对拇指指骨间关节主要起背伸作用,因此胸小肌移植重建拇对掌功能时,应同时重建拇短展肌功能,才有可能纠正在拇对掌功能重建术后出现的拇指指骨间关节屈曲畸形。     

示指伸肌缺如1例

<正>在制作一左上肢肌肉标本过程中,见其示指伸肌缺如图。为积累国人肌肉变异资料,现报道如下(图)。1正常示指伸肌起自拇长伸肌远侧的桡、尺骨背面及邻近的骨间膜,其肌腱与指伸肌肌腱一起通过伸肌支持带深面,穿过伸肌腱鞘,在第掌骨头对面2与到示指的指伸肌腱尺侧部联合。该标本前臂后群肌指伸肌深面和拇长伸肌内侧无起自桡、尺骨至示     

人拇长屈肌和拇长伸肌的肌纤维型构成及年龄差异

采用尸检取材（死后２４ｈ内）共１７例，用肌球蛋白ＡＴＰ酶染色法，研究了不同年龄组拇长屈肌和拇长伸肌的肌纤维型构成。结果表明，各年龄组肌纤维型比例明显不同，Ⅰ型纤维比例在少儿组较高，中青年组较低，到老年组又见增高。方差分析表明，年龄组之间存在显著差异。此外，在中青年组和老年组，拇长伸肌的Ⅰ型纤维比例显著高于拇长屈肌；而在少儿组，两肌之间无明显差异。本文讨论了肌纤维型构成与肌功能适应的关系。     

双侧拇长展肌、拇短伸肌变异一例

作者在解剖操作中于一男性尸体上发现一例双侧拇长展肌双肌腹、三肌腱,拇长展肌肌腹与拇短伸肌肌腹相融合变异,与早前报道的一例相关变异案例相比[1],此变异的肌腱数移行为3根（早前报道的为2根）,同时出现了两肌肌腹融合的情况（早前报道并未涉及）,故此变异类型较为罕见,现报道如下。1一般资料左侧拇长展肌（图1）于肌腹中下1/3处分出第     

胸小肌移植重建拇对掌功能的临床解剖研究

目的:为吻合血管神经的选择性胸小肌移植重建拇对掌功能术式提供解剖学依据。方法:在20侧成人胸部及手部标本中,解剖观察胸小肌的血管神经分布及胸小肌和大鱼际肌的形态、大小并将二者进行比较;然后按照大鱼际肌纤维走行方向,参考血管神经位置,将胸小肌修剪合适后移植固定于同侧手部大鱼际,模拟正常手部拇对掌功能予以牵拉,观察标本手部拇对掌过程。结果:胸小肌位置恒定,具备独立的动、静脉和神经支配;有针对性地选择部分胸小肌进行移植模拟,获得了标本手部的拇对掌过程。结论:在标本上选取部分胸小肌移植于手部大鱼际重建拇对掌功能的术式是可行的。     

Anatomic variation of the 5th extensor tendon compartment and extensor digiti minimi tendon

Anatomic variation within the 5th extensor compartment may contribute to the development of tenosynovitis and limit the usefulness of the extensor digiti minimi (EDM) for tendon transfer. The purpose of this study was to assess the anatomic variation of the EDM tendon and its surrounding retinaculum, with particular attention to anatomical variation between specimens. Forty-one fresh cadaver hands were dissected. The length of the 5th compartment retinaculum was noted. The incidence of an intercompartmental septum was noted in each specimen as well as the type of tendinous attachments present between the EDM and extensor digitorum communis (EDC) tendons. The presence and length of any accessory retinacular bands distal to the edge of proper extensor retinaculum was also noted. Only one specimen contained a single EDM tendon, while 71% (n = 29) of specimens contained two slips and 23% (n = 9) had three slips; 24% (n = 10) of EDC tendons had no slip to the small finger, while 61% (n = 25) of specimens had a single slip to the small finger. The EDC's contribution to the small finger was found to be an independent tendon in 42% of cases (n = 17), while 34% (n = 14) of specimens were found to have a common EDC slip, which branched to both the ring and small finger. Three EDM tendons divided distal to the extensor retinaculum, while the remaining EDM tendons divided beneath or proximal to the extensor retinaculum. Seventy-three percent (n = 30) of the specimens had an accessory retinacular band surrounding the EDM tendon identified at the base of the 5th metacarpal. Eighty-eight percent (n = 36) of hands had a septum between the EDM slips. The surgeon should be aware of variability within the 5th dorsal compartment in cases of trauma and in cases of tendon transfer. In our series 30 of 41 specimens were noted to contain an accessory dorsal retinacular band surrounding the EDM and 36 specimens were noted to contain a septum within the 5th compartment. The presence of an accessory retinacular band surrounding the EDM at the level of the 5th metacarpal base is an anatomic finding that requires further investigation.     

、趾短伸肌应用解剖及去神经游离移植的临床应用

目的：旨在为、趾短伸肌去神经游离移植修复腭裂、腭咽闭合不全、面瘫等提供形态学基础。方法：①对２２只足标本的、趾短伸肌的形态变异及神经支配进行解剖观察；②在１０９例手术中以神经刺激仪确认、趾短伸肌的神经，并测肌的长度，体积及重量。结果：①、趾短伸肌与长腱合并机会分别为５５．７％、６２．８％；趾短伸肌发出腱至第５趾的占７６．９％；②肌的神经支配三种类型比率分别是２４．４％、３２．８％、４２．７％；③肌的长度在８．３～１３．１ｃｍ，体积１．８～３．１ｃｍ３，重量１．９～３．２ｇ。结论：、趾短伸肌肌腱有与长腱合并的变异，趾短伸肌腱常有发出第五趾者；神经支配有三型；肌的长度、重量、体积适合肌肉游离移植的成活，是腭裂、腭咽闭合不全、尿道上裂及面瘫等外科治疗可靠的组织移植材料。     

The extensor indicis et medii communis

The aim of this study was to examine the existence of the extensor indicis et medii communis in detail. Thirty-one randomly selected adult cadavers (62 upper extremities) were examined for this project (22 males and 9 females between the ages 38 and 87). The muscle was observed in 3 of 62 hands, an incidence of 4.8%. One was in the right and the other two were in the left hands. Mean length and width of the muscle belly were 4.5 +/- 0.8 and 0.8 +/- 0.3 mm, respectively. Although the muscle did not have a junctura tendinum attachment between its two tendons, in one hand, the tendon to the index finger gave a thin slip to the tendon of the extensor digitorum communis for the same finger. Knowledge of variant muscle may be important when one is assessing the traumatized or diseased hand.     

The anatomical variations of the extensor tendons to the dorsum of the hand

To lead a quality life, tendon repair must be performed in a trauma causing damage to the extensor tendon of the hand. The aim of this study is to study the structures that can be used as donor tendons. Fifty-four dissected adult hands were examined to study the pattern of the extensor tendons on the dorsum of the hand. The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum (ED)-index; a single ED-index; a single ED-middle; a single ED-ring; an absent ED-little; a double extensor digiti minimi (EDM), and a single ED-ring to the little finger. The frequency of the number of tendons is as follows: a single (87.03%) EIP, a single ED-index (100%), a single (92.6%) ED-middle, a single (75.9%) ED-ring, and an absent (68.5%) or a single (24.1%) ED-little. A double (88.9%) EDM tendons were seen. The thickest type of juncturae tendinum (JT) is found primarily between the ring and little fingers (90%). Suitable excessive tendon and the thickest JT as donor tendon were found in the fourth intermetacarpal space. The present findings, especially the fourth intermetacarpal space, may explain why incisions on the dorsum of the hand should be large and performed with particular care. It is necessary to have a thorough understanding of the arrangements of the multiple extensor muscles and their junctural connections of the hand when tenoplasty or tendon transfer is required.     

伸指腱器终腱的形态特点及其临床意义

目的 :探讨伸指腱器终腱的解剖学特点和槌状指损伤的病理机制 ,为临床治疗提供依据。方法 :对新鲜成人尸体示、中、环、小指各 2 0指的伸指腱器终腱特点进行了解剖学测量 ,并对终腱的滑动距离进行了动态观察和测量。结果 :各指伸指腱器终腱的形态结构大体相似 ,但是中指 (17.12± 3 .3 )mm和环指 (16.3 3± 2 .9)mm的长度明显长于示指 (14 .73± 4.1)mm和小指 (10 .91± 2 .5 )mm ,具有显著性差异 (P<0 .0 1) ,并测出了各指终腱薄弱区的位置 5 .5～ 8.6mm ;同时检测了终腱运动功能与外力的关系 ,当近侧指间关节 (PIP)伸直时终腱的滑动距离较PIP屈曲时减少 40 %以上 ,表明终腱对外力的缓冲能力也减少了40 %。结论 :伸指腱器终腱的薄弱区是断裂的易发部位 ,也是功能重建的关键部位 ;终腱的形态结构、运动功能和外力是产生槌状指的三要素     

指背腱膜的功能解剖及临床意义

目的：进一步探讨指背腱膜的构成特点及临床意义。方法：在30只成人手标本上，通过模拟手术，对指背腱膜的构成特点进行了应用解剖学观测。结果：指背腱膜的构成复杂，其中的外侧腱束、外侧束、外侧腱和中央束在手指畸形的发生中有着特殊的临床意义。外侧腱束主要形成伸近节指间关节的功能解剖机制；其与外侧束形成的密切纤维联系而具有协同外侧腱的功能；该腱束与屈肌腱鞘有联系又使其具有平衡屈肌和伸肌肌力的作用。中央束在指背腱膜的整体协调、畸形的发生及矫正过程中起着重要的功能。结论：通过对指背腱膜的解剖研究，可用以解释因指屈、伸肌腱平衡被破坏后所形成的畸形，并可进一步探讨畸形的发生机理和解决这些畸形的新术式。     

复合组织移植一期修复复杂指背腱膜损伤

目的:报道应用复合组织移植一期修复复杂指背腱膜损伤的临床疗效。方法:采用掌背动脉为蒂带肌腱手背逆行岛状皮瓣、足背动脉为蒂带趾长伸肌腱复合组织皮瓣及肌腱移植锁骨下带蒂皮瓣3种方法修复,为36例合并皮肤缺损的复杂指背腱膜损伤进行急诊修复。结果:36例全部成活,随访1￣5年,按TA M功能评定法:优11例、良20例、差5例,优良率86.1%。结论:(1)对合并皮肤缺损的复杂指背腱膜损伤根据伤情,较大面积的手背手指皮肤肌腱缺损,以足背动脉为蒂带趾长伸肌腱复合组织皮瓣修复;(2)手指近节皮肤肌腱缺损,以掌背动脉为蒂带肌腱手背逆行岛状皮瓣修复;(3)手指中远节皮肤肌腱缺损,以肌腱移植锁骨下带蒂皮瓣修复,可获得良好疗效。     

Examination of the accessory tendons of extensor hallucis longus muscle in fetuses

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty-five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16-21 weeks), Group B (22-27 weeks), and Group C (28-34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty-two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL-AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe.     

A quantitative assessment of muscle spindle formation in reinnervated and non-reinnervated grafts of the rat extensor digitorum longus muscle

Free grafting of the rat extensor digitorum longus muscle disrupts the neurovascular supply and results in degeneration and subsequent regeneration of both muscle and nerve. Reinnervation of one group of grafts was prevented by severing and ligating the sciatic nerve. Thirty days after surgery, the number of muscle spindles in each graft was determined by examination of serial sections at the light-microscopic level. Non-operated control muscles contained 37.86 ± 3.02 (s.d.) spindles per muscle. Means for the reinnervated and non-reinnervated grafts were 15.63 ± 3.89 and 18.38 ± 5.15 respectively. At the time of surgery, all of these grafts had been treated with 0.75% bupivacaine, a local anesthetic which, combined with the grafting technique, ensures degeneration of all muscle fibers. An additional group of grafts was not subjected to this treatment and contained a mean of 27.40 ± 2.19 spindles.The embryogenesis of muscle spindles is dependent upon interaction between sensory nerves and developing myotubes. The conditions for the formation of these stretch receptors in regenerating muscle have been less clear. Their formation in non-reinnervated grafts demonstrates that this process, unlike spindle development in the embryo, does not require the presence of nerves. When reinnervation of a graft is allowed, large numbers of nerve fibers have been observed in muscle spindles. It is not yet known whether or not the normal pattern of innervation, essential for proper function of the spindle, is restored.