TFCC损伤导致腕尺侧痛的解剖学研究及其意义

目的　研究TFCC的解剖构成,明确TFC周围韧带的组成及神经分布,为开展支配神经切除术治疗腕尺侧痛的术式奠定基础。 方法 对30例成年男性腕关节标本进行解剖,首先观察腕尺侧组织及TFCC的神经支配,之后观察TFC周围韧带的组成及起止。 结果　(1)TFCC的韧带组成除包括国内外报道的尺月韧带、尺三角韧带（均抵止于对应腕骨掌侧）、桡尺骨远端韧带、尺侧副韧带、尺侧腕伸肌腱鞘之外,还包括新观察到的尺月、尺三角背侧韧带。(2)腕尺侧及TFCC的神经支配主要来自于尺神经手背支的腕关节支。 结论 （1） TFCC的尺月、尺三角韧带不仅止于对应腕骨的掌侧,同时也发出纤维抵止于对应腕骨的背侧。（2） 腕尺侧及TFCC的神经支配主要来自于尺神经手背支的腕关节支,因此TFCC或尺神经手背支腕关节支损伤为腕尺侧痛的解剖学基础。     

三角纤维软骨复合体的解剖学研究

目的;研究三角纤维软骨复合体（TFCC）的形态结构特点,为临床和进一步的生物力学研究提供解剖学基础。方法：在23侧成人尺体上肢标本上对三角纤维软骨复合体的诸结构进行解剖观测。用游标卡尺测量韧带的长度、宽度和厚度及腕关节盘的桡侧缘、掌侧腕伸肌腱鞘,尺侧囊,尺三角韧带,桡尺三角韧带及尺月韧带等。关节盘同系物和茎突前隐窝有三个类型即窄开口型、宽开口型和闭口型。结论：TFCC是一复合组织结构,是维持桡尺远侧关节稳定性的重要结构。     

肘关节副韧带的MRI检查方法及影像特点

目的：研究肘关节有关结构的MRI检查方法和影像特点。方法：急性肘关节后脱位2例和慢性肘关节后脱位1例，行MRI检查。结果：冠状位MRI可清楚地显示肘关节诸结构，并可显示损伤的肝关节副韧带，矢状位部分层面可分别显示尺侧和桡侧副韧带，横断面不能完整地显示肘关节副韧带。副韧带损伤的常规MRI影像特点，在冠状位SE序列T2加权像，呈低信号，尺侧副韧带在尺骨冠突内侧呈薄止点，线型或稍呈弧形向近端，在肱骨骨侧髁止点稍扩散，其损伤的表现有韧带的增厚或变薄、韧带松驰及不连续包绕韧带的水肿或血肿的高信号影等。结论：肘关节副韧带的MRI检查是较准确、敏感、无损伤的方法，值得进行进一步探讨。     

带血供肱骨下段内侧骨（膜）瓣移位术的应用解剖

目的：为带血供肱骨下段骨瓣移位术提供解剖学基础。方法：４０侧成人上肢标本，观测尺侧下副动脉、尺侧返动脉的起始、走行、分支分布、骨膜支和吻合。结果：尺侧下副动脉距髁间连线上３．７±１．７ｃｍ始于肱动脉，外径１．８±０．４ｍｍ，长１．８±０．７ｃｍ，骨膜支１～３支，外径０．８±０．４ｍｍ分布肱骨下段内侧半骨膜。尺侧返动脉前干外径１．１±０．２ｍｍ。尺侧上副动脉、尺侧下副动脉、尺侧返动脉在肱骨内上髁附近互相吻合。结论：利用上述血管吻合关系，设计带血供的肱骨（膜）瓣或骨皮瓣，可移位修复肱骨中上段、尺、桡骨中段骨折骨不连。临床应用已取得良好效果。     

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。     

肘关节稳定性的应用解剖和生物力学研究

目的 :为临床认识和治疗急、慢性肘关节不稳定提供基础。方法 :解剖观察肘关节副韧带的形态结构特点 ,测量依序切断桡侧软组织 (包括桡侧副韧带 )时肘关节后外侧旋转度的变化、依序切断肘关节尺侧副韧带时其外翻旋转角度的变化。结果 :①尺侧副韧带前束可分为前部纤维和后部纤维 ;桡侧副韧带部分止于环状韧带 ,部分止于尺骨冠突的外下方。②屈曲 60°以前 ,尺侧副韧带前束的外侧部紧张而内侧部较松弛 ,肘关节屈曲超过 60°后 ,前束内外侧处于同等程度的紧张状态 ;后束在肘关节屈曲超过 90°后才被拉紧。③肘关节桡侧副韧带复合体对维持关节外侧的稳定作用约占 5 0 % ,伸肌及伸肌腱膜起协同作用。结论 :肘关节副韧带是维持肘关节稳定的重要结构 ,在肘关节的运动过程中 ,副韧带的不同组成部分发挥着不同的作用 ,其中桡侧尺副韧带和尺侧副韧带前束是肘关节主要的稳定结构     

腕关节盘的解剖学研究及临床意义

目的：观察研究腕关节盘的形态及其和周围组织关系。方法：采用２０只成人手标本,观察关节盘的形态,附着点的周围骨、软组织结构的关系,对关节盘的附着点作了深入的研究。结果：研究表明腕关节盘位于腕关节的特殊位置,其尺侧附着尺骨茎突和尺骨茎突陷窝两部分,并和桡尺远端侧副韧带存在密切关系。结论：腕关节盘对桡腕关节、桡尺远侧关节稳定性起重要作用,其在尺骨茎突的附着点对尺骨茎突骨折及功能有重要影响。     

肘关节后外侧旋转不稳定的解剖与生物力学研究

目的研究肘关节外侧软组织对维持肘关节后外侧旋转稳定的作用。方法通过解剖肘关节观察外侧软组织的形态结构特点;通过生物力学实验研究其序列切断时肘关节旋转度的变化。结果肘关节伸肌起始于防骨gF＃的肌健膜上,肌胞膜部分随肌肉走行成为肌间隔,部分止于尺骨鹰嘴外侧骨面;烧侧副韧带止于尺骨冠突的部分为侥侧尺副韧带,其与烧骨环状韧带在尺骨上的止点有2种类型：I型,榜顺IJ韧带的部分纤维汇入烧骨环状韧带的尺骨止点,另一部分纤维单独止于稍远的尺骨上;11型,按顺觑带与愧骨环状韧带形成一宽的纤维止于尺骨上。肘关节侥侧副韧带…     

改良肘关节内侧入路尺侧副韧带手术的应用解剖

目的：为肘关节经肌肉入路尺侧副韧带（ＵＣＬ）修复术提供解剖学基础。方法：成人肘关节标本３５侧,解剖观察尺侧副韧带前束、肘部屈肌总腱及尺、正中神经分支的解剖关系,并行摹拟手术。结果：ＵＣＬ前束起于肱骨内侧髁的前下方,止于尺骨冠突内侧的小结节,ＵＣＬ前束位于尺侧腕屈肌肱头、尺头之间的深层;尺神经在肘管中部与尺侧副韧带前束的平均距离为（０．９ ± ０． １）ｃｍ,在肘管的远侧出口,距尺侧副韧带的尺骨止点（０．６±０．３）ｃｍ;尺神经至尺侧腕屈肌尺头肌支的入肌点距肱骨内侧髁的距离为（３．７±０．８）ｃｍ;正中神经最靠近切口的分支距切口的距离,在肱骨内侧髁和尺骨结节水平分别为（１．６±０．５）ｃｍ和（０．９±０．４）ｃｍ。结论：经尺侧腕屈肌的肱头和尺头之间、自肱骨内侧髁向前外侧至ＵＣＬ尺骨止点以远约２ ｃｍ为一损伤较小的安全手术入路。     

腕部尺神经卡压的解剖学研究及其临床意义

目的：为腕部尺神经卡压的诊断和治疗提供解剖学依据。方法：对20例新鲜成人上肢标本的腕部进行解剖，观测尺神经行径中可能存在的卡压因素。结果：尺神经在腕尺管内分成浅、深两支，浅支于小鱼际肌腱弓浅面出腕尺管；深支在小鱼际肌腱弓深面穿出腕尺管后，走行于小指对掌肌浅、深两头腱性起点和钩骨钩之间的间隙，小指对掌肌浅头腱性起点近侧缘锐利成腱弓样，存在率100％。腕尺管内尺神经和尺动脉之间存在3种交叉伴行关系：尺动脉发出的小鱼际肌营养血管和尺神经深支交叉占10％，尺动脉深支和尺神经浅支交叉占20％，尺动脉深支和尺神经深、浅支分别交叉占70％。结论：尺神经在腕部的行程分为腕尺管段和小鱼际肌段，小指对掌肌腱弓可以卡压尺神经深支，尺动脉和尺神经之间的多种交叉伴行关系是尺动脉卡压尺神经的基础。     

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.     

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.     

膝关节后交叉韧带断裂对内侧副韧带组织学的影响

背景：通过比较Ⅰ型胶原、Ⅲ型胶原相对数量和Ⅰ/Ⅲ型胶原的比值可以一定程度上判断韧带的组织学性能。 目的：观察膝关节后交叉韧带断裂兔保持较低生理负荷和活动度时内侧副韧带组织学的变化。 方法：24只成年雄性家兔双侧膝关节配对为自身对照,实验侧行后交叉韧带完全切断,对照侧只暴露后交叉韧带而不切断,造模后第8,16,24,40周随机处死6只实验兔。进行苏木精-伊红染色,天狼猩红染色检测Ⅰ型和Ⅲ型胶原的相对数量。 结果与结论：①苏木精-伊红染色结果：8,16,24周两组内侧副韧带胶原分布、排列无明显差别;40周时实验组胶原纤维较对照组稀疏。②天狼猩红染色结果：8,16,24周实验组内侧副韧带的Ⅰ型和Ⅲ型胶原纤维总和分别较对照组显著增加(P < 0.05);40周时实验组较对照组显著减少(P < 0.05);8周实验组和对照组之间内侧副韧带的Ⅰ/Ⅲ型胶原纤维的比值差异无显著性意义(P > 0.05);16,24,40周时实验组比值显著分别小于对照组(P < 0.05)。说明兔膝关节后交叉韧带损伤后短期内对内侧副韧带组织学特性无明显影响,随着时间延长,组织学特性显著下降。     

肘部断层解剖学研究

目的为肘部临床影像学诊断提供解剖学依据。方法利用40侧成人尸体肘部,制作成横、矢、冠三个方位的连续断层标本,观测肘关节所在各断面的结构安排,关节腔宽度。结果肱尺关节腔为0.70±0.44mm,肱桡关节腔为0.69±0.44mm,桡尺近侧关节腔为0.90±0.56mm;关节软骨厚度,骨关节软骨厚度为1.15±0.35mm,尺骨关节软骨厚度为1.04±0.16mm,桡骨关节软骨厚度为0.98±0.17mm;侧副韧带尺侧副韧带厚度为1.38±0.42mm,桡侧副韧带厚度为1.32±0.42mm。结论肘部横、矢、冠断层能从三维角度清晰地显示肘关节各关节腔、关节软骨、侧副韧带,以及正中神经、尺神经及桡神经与肘关节的关系。     

Functional anatomy of the lateral collateral ligament complex of the elbow

Postero-lateral instability of the elbow joint is a rare clinical condition, commonly related to a disruption of the lateral collateral ligament complex of the elbow. Twenty elbow joint specimens were studied in order to describe the morphologic characteristics of this complex, and to determine the role of its different components in the stability of the elbow. After a morphologic and morphometric investigation, serial divisions of the medial bundle of the lateral collateral ligament were performed, with or without section of the annular ligament and the anterior bundle of the lateral collateral ligament. The anterior and medial bundles of the lateral collateral ligament had close relationships with the annular ligament and a common proximal course. Isolated section of the medial bundle of the lateral collateral ligament induced only minor laxity of the elbow joint. Combined divisions of the medial and the anterior bundles at their humeral insertion, or the medial bundle and the annular ligament at their ulnar insertion resulted in a reproducible subluxation of the ulno-humeral joint. Thus, postero-lateral rotatory stability of the elbow joint is largely maintained by the lateral collateral ligament complex, composed of three elements: the anterior and medial bundles of the lateral collateral ligament, and the annular ligament. In clinical practice, chronic postero-lateral instability is best treated by a ligamentous reconstruction, that must take into account all these anatomic considerations. We report here a new technique of ligamentoplasty using the fascia of the extensor carpi ulnaris muscle.     

Detailed anatomy of the antebrachiocarpal joint in dogs

A comparative study of the anatomy of the antebrachiocarpal (AC) articulation was carried out in 30 adult dogs with 60 joints. Although a considerable degree of similarity was found between the AC joint in dogs and the corresponding wrist joint in humans, a number of differences between these two homologous joints were also noted. The distal end of the ulna in dogs directly articulates with the ulnar carpal and accessory carpal bones forming a specialized antebrachiocarpal arrangement more adapted to running. The accessory carpal bone in dogs is a massive, long bone and is strikingly different from its homologue in humans, the pisiform bone. The joint between the accessory and ulnar carpal bones, which corresponds to the piso-triquetral joint in humans, is always connected with the AC joint, whereas in humans this communication could be found occasionally. The large radial carpal bone in dogs, characteristic for carnivores, corresponds to the fused scaphoid and lunate bones in humans, in whom this type of fusion is very rarely found. The palmar ulnocarpal and radiocarpal ligaments in dogs are distinctly intra-articular, whereas in humans these ligaments are intracapsular. One of the controversies of the AC joint in dogs is a structure located between the distalmost parts of the radius and ulna forming a strong bond between these two bones and a part of the antebrachial articular surface. It is cartilage-like and is composed of typical fibrocartilagineous tissue. Considering its location, form, and function, this structure in dogs should be regarded as the articular disc and so-named; it is also concluded that it is a homologue to the articular disc of the distal radioulnar joint in humans. © 1992 Wiley-Liss, Inc.     

Detailed anatomy of the antebrachiocarpal joint in dogs.

A comparative study of the anatomy of the antebrachiocarpal (AC) articulation was carried out in 30 adult dogs with 60 joints. Although a considerable degree of similarity was found between the AC joint in dogs and the corresponding wrist joint in humans, a number of differences between these two homologous joints were also noted. The distal end of the ulna in dogs directly articulates with the ulnar carpal and accessory carpal bones forming a specialized antebrachiocarpal arrangement more adapted to running. The accessory carpal bone in dogs is a massive, long bone and is strikingly different from its homologue in humans, the pisiform bone. The joint between the accessory and ulnar carpal bones, which corresponds to the piso-triquetral joint in humans, is always connected with the AC joint, whereas in humans this communication could be found occasionally. The large radial carpal bone in dogs, characteristic for carnivores, corresponds to the fused scaphoid and lunate bones in humans, in whom this type of fusion is very rarely found. The palmar ulnocarpal and radiocarpal ligaments in dogs are distinctly intra-articular, whereas in humans these ligaments are intracapsular. One of the controversies of the AC joint in dogs is a structure located between the distal-most parts of the radius and ulna forming a strong bond between these two bones and a part of the antebrachial articular surface. It is cartilage-like and is composed of typical fibrocartilaginous tissue.(ABSTRACT TRUNCATED AT 250 WORDS)