拇指腕掌关节韧带的解剖学特点及其临床意义

目的　研究拇指腕掌关节韧带的解剖学特点及各韧带在拇指运动中的作用,为韧带重建提供形态学基础。 方法　放大镜下解剖成人男性尸体20例新鲜手标本,观察拇指腕掌关节韧带的起止点及附着部位,分别测量各韧带在中立位下的长、宽、厚及最大拉伸长度,测量关节的活动范围。 结果　拇指腕掌关节周围共5条韧带,其中桡背韧带、后斜韧带、前斜韧带为囊内韧带,第1骨间韧带、尺侧韧带为囊外韧带。在囊内韧带中,最厚的是桡背韧带（2.08±0.27） mm,最薄的是前斜韧带（1.14±0.17） mm。最宽的是前斜韧带（9.33±1.09） mm,最窄的是后斜韧带（7.23±0.88） mm。延伸率最大的是桡背韧带（57.33±9.21%）,最小的是前斜韧带（38.43±8.26%）。 结论　拇指腕掌关节存在三级稳定结构,在关节囊韧带中,桡背韧带厚韧而紧张,对维持关节稳定性起重要作用,前斜韧带薄而松弛,外伤或自发性劳损引起退行性变可能性较大,拇指腕掌关节炎应该首选重建前斜韧带。     

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。     

拇指腕掌关节韧带的解剖力学分析及临床意义

目的研究拇指腕掌关节背桡韧带及前斜韧带的解剖学及生物力学特点,测量其弹性模量及延伸率,为伤病时韧带修复提供参考。方法解剖成人男性尸体40例新鲜手标本,制做成大多角骨-韧带-第1掌骨标本,20例保留背桡韧带,20例保留前斜韧带,在生物力学机上测试,测量和计算背桡韧带及前斜韧带的长、宽、厚、最大载荷、弹性模量、延伸率。结果背桡韧带、前斜韧带的最大载荷分别为(213.5±72.4)、(168.7±35.2)N,弹性模量分别为(17.2±6.7)、(9.3±2.5)MPa,延伸率分别为(116.2±21.3)%、(92.7±22.4)%。背桡韧带的最大载荷、弹性模量及延伸率均大于前斜韧带。结论拇指腕掌关节囊内韧带中,背桡韧带刚度较大,韧性较强,对维持关节稳定性起重要作用。前斜韧带刚度较小,韧性较差,韧带退变时容易损伤。拇指腕掌关节炎应该首选重建前斜韧带,且应选用弹性模量及延伸率接近背桡韧带的材料为佳。     

拇指腕掌关节韧带的力学特性及其意义

目的 :探讨拇指腕掌关节韧带力学特性 ,为关节运动分析、伤病致残时的修复与功能重建以及人工关节设计提供关节韧带力学特性参数。方法 :选择前斜韧带和背桡侧韧带做离体力学测试 ,得出韧带应力—应变关系、弹性模量和抗张强度 ,推导出本构方程。结果 :前斜韧带和背桡侧韧带的应力—应变关系呈幂函数关系 ,前斜韧带的本构方程 :σ =1.0 0ε1.17,背桡侧韧带的本构方程 :σ =2 .2 7ε1.60 。结论 :前斜韧带结构较疏松 ,其弹性模量和抗张强度都较背桡侧韧带小 ,外伤或自发性损伤引起退行性变的可能性大。     

拇指腕掌关节韧带损伤的生物力学研究及临床治疗

对9只正常尸体手标本利用生物力学实验方法,分析了拇指腕掌关节的背韧带、外侧韧带和掌侧韧带对关节稳定性所起的不同作用。实验结果:拇指屈曲和外展时,背侧及外侧韧带对稳定关节起主要作用;伸拇运动时,掌侧韧带对稳定关节起主要作用,因此,当拇指腕掌关节脱位时,应主要修复背侧和外侧韧带。对7例陈旧性拇指腕掌关节脱位的病人进行背侧和外侧韧带的修复,随访8～37个月,证明有很好的治疗效果。     

拇长展肌腱束转位重建多韧带手术治疗第1腕掌关节脱位

目的　报道拇长展肌腱束转位重建第1腕掌关节后斜韧带及背桡侧韧带手术治疗第1腕掌关节脱位的临床疗效。 方法　自2015年1月至2019年12月，对5例第1腕掌关节脱位患者实施关节复位、克氏针牵引固定及拇长展肌腱束重建第1腕掌关节后斜韧带和背桡侧韧带手术，术后4周去除外固定并拔除克氏针开始功能锻炼。根据X线片、拇指关节活动范围（range of motion，ROM）评价手术效果。 结果　术后随访5~12个月（平均8个月）。末次随访复查X线片无关节再脱位；ROM检测，4例屈伸、收展活动恢复正常，1例对掌受限。 结论　采用拇长展肌腱束转位重建第1腕掌关节韧带，可恢复关节稳定性，改善功能。     

带血管蒂管5腕掌关节移位的应用解剖学

目的为带血管蒂的第5腕掌关节移位修复和重建手的功能性关节提供解剖学基础.方法22侧冷冻成人上肢标本,显微解剖观测第5腕掌关节的结构特点、关节面的形状、血供来源、神经支配、韧带的构成及长、宽、厚度,并测量关节的活动度.模拟设计以腕背动脉网及其分支为蒂的第五腕掌关节移位术.结果①第5腕掌关节为鞍状关节,具有屈伸39.16°±4.24°的活动范围.②第5腕掌关节的血供来自掌深弓尺侧返支、第4掌背动脉近端的关节支和尺动脉手背支、腕掌网和腕背网的分支.③第5腕掌关节由尺神经支配,掌侧为尺神经深支的分支,背侧为尺神经手背支分支.结论可设计以掌背血管筋膜为蒂的逆行和以桡动脉腕背支筋膜为蒂的顺行第5腕掌关节移位,用于修复和重建拇指腕掌关节和第2～5掌指关节.     

带血管蒂第5腕掌关节移位的应用解剖学

目的 :为带血管蒂的第 5腕掌关节移位修复和重建手的功能性关节提供解剖学基础。方法 :2 2侧冷冻成人上肢标本 ,显微解剖观测第 5腕掌关节的结构特点、关节面的形状、血供来源、神经支配、韧带的构成及长、宽、厚度 ,并测量关节的活动度。模拟设计以腕背动脉网及其分支为蒂的第五腕掌关节移位术。结果 :①第 5腕掌关节为鞍状关节 ,具有屈伸 3 9.16°± 4.2 4°的活动范围。②第 5腕掌关节的血供来自掌深弓尺侧返支、第 4掌背动脉近端的关节支和尺动脉手背支、腕掌网和腕背网的分支。③第 5腕掌关节由尺神经支配 ,掌侧为尺神经深支的分支 ,背侧为尺神经手背支分支。结论 :可设计以掌背血管筋膜为蒂的逆行和以桡动脉腕背支筋膜为蒂的顺行第 5腕掌关节移位 ,用于修复和重建拇指腕掌关节和第 2～ 5掌指关节     

肌腱移位治疗第1腕掌关节脱位的解剖学研究进展

第1腕掌关节（即拇指腕掌关节）脱位是临床骨科常见腕掌部损伤，其发生机理为第1掌骨受到轴向并尺侧暴力打击，致使第1掌骨向背侧、桡侧近端移位。常伴有第1腕掌关节周围韧带断裂。如果未得到及时正确的处理，愈后常有关节不稳定，影响拇指对掌及外展功能。经典的治疗第1腕掌关节脱位方法有手法复位加夹板外固定，手术切开复位克氏针内固定、术后石膏外固定。腕掌关节脱位基本上都伴有周围肌腱断裂，以上两类治疗方法修复后肌腱抗拉力也会显著降低，术后复发的可能性大，特别是在早期进行功能锻炼时容易发生。     

近侧指间关节掌板损伤应用解剖学研究及临床治疗

目的：探讨近侧指间关节（PIP）掌板损伤对近侧指间关节稳定性及晚期关节屈曲挛缩的影响,同时评价临床治疗效果。方法：（1）新鲜尸体20个手指,观察PIP关节掌板及其周围韧带的解剖学特点,并进行掌板损伤模拟实验。（2）手术治疗PIP掌板损伤12例,其中新鲜损伤7例,陈旧损伤5例。结果：（1）切断掌板远端连接韧带后,掌板向近端回缩,其断端合拢时PIP关节屈曲度为35°～50°。掌板远端切断后背伸度为（23．4±6．6）°,掌板和单侧侧副韧带同时切断后背伸度为（51．3±7．8）°,而侧搬度为（41．8±5．5）°。（2）12例患者术后随访3～13个月。新鲜病例7例,PIP关节主动背伸为0—15°,平均8°;屈曲基本正常。陈旧病例关节松解术3例5次,关节挛缩均复发;掌板松解、指浅屈肌腱切断后长期使用弹性支具1例,症状明显改善;掌板松解和2区伸肌腱切断1例,基本恢复正常。结论：掌板损伤后向近侧退缩粘连和瘢痕挛缩是晚期关节屈曲挛缩的主要原因;掌板损伤以早期修复为佳,晚期关节松解效果差,以单纯掌板松解为宜。     

喙肱韧带的应用解剖

目的:探讨喙肱韧带(coracohumeral ligament,CHL)的解剖学特点。方法:观察20侧正常成人肩关节标本的CHL位置、形态、起止点及与盂肱上韧带的关系;CHL在肩关节各种活动中所处的状态;CHL与关节囊融合处、CHL根部组织、关节囊及喙肩韧带组织学特点。结果:20侧CHL全部起于喙突基底部的外侧缘;9侧止于冈上肌腱,7侧止于肩袖间隙,3侧止于冈上肌腱和肩胛下肌腱,1侧止于肩胛下肌腱;其中11侧可见CHL与盂肱上韧带存在纤维组织连接;CHL于肩关节旋外、前屈、后伸、内收、肱骨头前后平动时紧张,于旋内、中立位、外展位时松弛;CHL与关节囊融合处、CHL根部组织与关节囊组织学特点相似,均呈现关节囊组织的典型特点,喙肩韧带呈现出韧带的特有表现。结论:CHL位置与形态相对固定,起点一致,但止点呈多样性;CHL与盂肱上韧带复合体不固定;CHL在不同运动状态其紧张度不一;CHL与关节囊组织形态相似,是关节囊增厚部。     

Osteoligamentous guidance of the movements of the human thumb

On examination of the thumbs of 20 dissected preparations of ligaments and joints, of ten dry skeletons and of a number of living hands, apoposition (from apo = away from) was distinguished as a position in which the first carpometacarpal joint is fully abducted and laterally rotated and in which one or both distal joints of the thumb are flexed. Apoposition is commonly used in writing and it has a specific osteoligamentous basis for its stability: (1) a Y-shaped intermetacarpal ligament is attached by two crura to the base of the second metacarpal bone and by a common stem to the first metacarpal. Together with the palmar and dorsal oblique ligaments it becomes taut at abduction and establishes thereby a fixed center for the circumduction. Stability is enhanced as the circumduction takes place in the radial flat part of the joint away from the center; (2) of the two palmar prominences of the head of the first metacarpal bone the radial is the larger. At 25–30° flexion in the metacarpophalangeal joint the prominence fits into an excavation on the base of the proximal phalanx in a manner which together with the ulnar collateral ligament locks the joint against mutual abduction and lateral rotation, and (3) the radial part of the trochlea of the interphalangeal joint is larger than the ulnar and secures, together with the ulnar collateral ligament, the joint against a radial luxation. Apoposition does not require activity of the thumb muscles; it is brought about by applying an external force to the ulnar side of the thumb and it is checked by ligaments and the shape of the joints.     

踝关节外侧韧带和距下关节韧带修复重建的应用解剖

目的 :为踝关节外侧韧带和距下关节韧带损伤修复重建提供解剖学基础。方法 :在 3 2侧经防腐固定、8侧冷藏新鲜标本上解剖观测踝关节外侧韧带和距下关节韧带及小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带 ,在新鲜标本上摹拟修复术。结果 :小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带解剖位置恒定 ,与踝关节外侧韧带和距下关节韧带相毗邻 ,具有一定的长、宽、厚度 ,可形成移植供体。结论 :①陈旧性踝关节外侧韧带和距下关节韧带的损伤 ,原位修复较难 ,用肌腱转位修复是一种可行的方法 ;②可用腓骨短肌腱修复距腓前和跟腓韧带损伤 ,小趾趾长伸肌腱和第 3腓骨肌腱转位修复距下关节韧带 ,伸肌下支持带可用作加强缝合 ,术式经标本摹拟具有可行性。     

髋前外侧关节囊与髂股韧带的应用解剖及临床意义

BACKGROUND: To repair and reconstruct the joint capsule and surrounding ligaments is one of effective methods against displacement and dislocation after total hip arthroplasty. In recent years, anterolateral total hip arthroplasty has been widely used, but little is reported on the anatomic features of the anterolateral hip joint capsule and iliofemoral ligament. OBJECTIVE: To investigate the anatomic features of the anterolateral hip joint capsule and iliofemoral ligaments, thereby providing anatomic evidence for selecting and optimizing the approach for total hip arthroplasty and for clinical practice. METHODS: Thirty adult cadaver hips fixed with formalin were used for this study. The anterolateral hip joint capsule and the iliofemoral ligaments were dissected and anterolateral hip joint capsules were divided into three sections and nine parts. The average thickness of each part and the average height and width of each section were measured. The anterolateral hip joint capsule was observed by its beginning and ending, course, branch and histological features. RESULTS AND CONCLUSION: The anterolateral hip joint capsule was tightly connected with the iliofemoral ligaments to form a complex. The thickness of the capsule was varied. The thinnest parts of the complex were BI and BII. In addition, the average height and width of each section were different. The joint capsule originating from the anterior inferior iliac spine and acetabulum was divided into three branches and fixed on the intertrochanteric line. Understanding of the anterolateral hip joint capsule and iliofemoral ligaments may make for the approach selection, design and optimization of total hip arthroplasty.      

A cadaveric study of the structural anatomy of the sternoclavicular joint

Pathologies of the sternoclavicular (SC) joint are infrequent and effective management is often hindered by a limited understanding of the anatomy. In this study, we did macroscopic evaluations of the ligaments, the intra‐articular disc, and the articulating surfaces of 25 SC joints. After removal of the joint capsule, the articulating surfaces of the sternal end of clavicle and the sternum were evaluated and the intra‐articular disc was macroscopically examined. The anterior SC ligament covered the intra‐articular disc, which divided the joint into a clavicular and a sternal part. A thin capsule, relatively lateral and medial from the anterior SC ligament, covered the two intra‐articular parts. This means that the anterior SC ligament can be used as a landmark to enter into clavicular or sternal part of the SC joint. Posteriorly, there was a thick capsule without soft‐spot or clear posterior SC ligament. Only the antero‐inferior surface of the sternal end of every clavicle was covered by cartilage. Of the intra‐articular discs 56% were incomplete. All of these incomplete discs displayed a central hole with signs of degeneration and fraying. This was associated with increased cartilage degeneration at the clavicular side. By experimental design (past and present), it would seem reasonable to assume that the incomplete types are caused by degeneration and are not developmental. Clin. Anat. 25:903–910, 2012. © 2012 Wiley Periodicals, Inc.