指深屈肌腱及指伸肌腱止点的解剖研究

目的　通过解剖研究指深屈肌腱及指伸肌腱在远节指骨基底掌侧和背侧止点平面的差别，为西摩骨折发生机制提供解剖学依据。 方法　手部残肢10具，其中左手3例，右手7例，均为男性患者，年龄24~58岁。2~5指分别有10指，全部手指无外伤手术史、无畸形。自远节指间关节水平掌侧及背侧分别切开，于末节指骨水平分离各指的指深屈肌腱及指伸肌腱，记录其与末节指骨掌侧及背侧关节面的距离，比较指深屈肌腱及指伸肌腱在末节指骨掌、背侧的止点水平。 结果　指深屈肌腱止点近端至关节面距离：示指（2.19±0.27）mm，中指（2.50±0.14）mm，环指（2.23±0.16）mm，小指（1.83±0.19）mm；指伸肌腱止点近端至关节面距离：示指（0.12±0.02）mm，中指（0.18±0.02）mm，环指（0.12±0.05）mm，小指（0.06±0.01）mm；各指差异有统计学意义（P＜0.05）。指深屈肌腱止点中点至关节面距离：示指（3.73±0.45）mm，中指（4.33±0.45）mm，环指（3.53±0.46）mm，小指（3.16±0.41）mm；指伸肌腱止点中点至关节面距离：示指（1.77±0.06）mm，中指（1.76±0.20）mm，环指（1.77±0.06）mm，小指（1.47±0.10）mm；各指差异有统计学意义（P＜0.05）。 结论　指伸肌腱在末节指骨基底的止点较指深屈肌腱的止点距关节面更近，为西摩骨折的发生机制提供了解剖依据。

Anatomical study on the insertion of flexor digitorum profundus tendon and extensor tendon

Objective　To study the differences of the volar and dorsal insertion of flexor digitorum profundus tendon and extensor tendon in the base of the distal phalanx and provide anatomical base for possible mechanism of Seymour fracture. 　Methods　10 hand specimens were collected from the anatomical laboratory of the hospital, including 3 left hand cases and 7 right hand cases, all of which were male patients，aged 24~58 years old. All 2~5 fingers were 10 fingers respectively, and all fingers had no history of traumatic surgery or deformity. The flexor digitorum profundus tendon and extensor tendon of each finger were cut apart from the level of the volar and dorsal interphalangeal joint and separated at the level of the distal interphalangeal joint. The distances from the insertion of flexor digitorum profundus tendon and extensor tendon to the volar and dorsal articular surfaces of the distal phalanx were recorded, and the insertion levels of the flexor digitorum profundus tendon and the extensor tendon at the volar and dorsal phalanx were compared.　Results　The distances from the articular surface to the proximal insertion point of the flexor digitorum profundus tendon for each finger were as follows: the index fingers (2.19±0.27) mm, the middle fingers (2.50±0.14) mm, the ring fingers (2.23±0.16) mm, and the little fingers (1.83±0.19) mm. The distances from the proximal extensor tendon insertion point to the articular surface for each finger were as follows: the index fingers (0.12±0.02) mm, the middle fingers (0.18±0.02) mm, the ring fingers (0.12±0.05) mm, and the little fingers (0.06±0.01) mm. The differences of each finger were statistically significant (P<0.05). The distances from the middle point of the insertion of the flexor digitorum profundus tendon to the articular surface for each finger were as follows: the index fingers (3.73±0.45) mm, the middle fingers (4.33±0.45) mm, the ring fingers (3.53±0.46) mm, and the little fingers (3.16±0.41) mm. The distances from the middle point of the insertion of the extensor tendon to the articular surface for each finger were as follows: the index fingers (1.77±0.06) mm, the middle fingers (1.76±0.20) mm, the ring fingers (1.77±0.06) mm, and the little fingers (1.47±0.10) mm. The differences of each finger were statistically significant (P<0.05).　Conclusions　The insertion point of the extensor tendon at the base of the terminal phalanx is much closer to the articular surface than that of the flexor digitorum profundus tendon, which provides anatomical basis for the mechanism of Seymour fracture.