近节指骨滑车损伤对近指间关节侧方稳定性影响的应用解剖学研究

目的　通过近节指骨滑车损伤实验，探究其对近指间关节侧方稳定性影响，为治疗提供解剖依据。 方法　解剖6具成人双上肢手标本，选择示指、中指、环指共36只手指进行研究。分别测量0 °屈曲位时近指间关节近节指骨滑车未损伤及桡侧损伤10%、20%、30%、40%、50%的桡偏角度。 结果　未损伤时近节指骨滑车两端长度平均为（10.25±1.12）mm，桡偏角度为（0.14±0.10）°，损伤10%时桡偏角度为（5.06±0.53）°，损伤20%时桡偏角度为（8.47±0.42）°，损伤30%时桡偏角度为（12.28±0.71）°，损伤40%时桡偏角度为（16.33±0.76）°，损伤50%时桡偏角度为（20.03±0.75）°。近节指骨滑车损伤程度越重，近指间关节桡偏角度越大，关节稳定性越差（P<0.0001，Wilcoxon检验）。 结论　近节指骨滑车缺损对近指间关节侧方稳定性具有显著影响，损伤达10%时即可发生侧方不稳定。

Anatomical observation on vertebral artery-dura mater arterial ductal ligament and its clinical significance

Objective　 To explore the fibrous connection structures between third section (V3 segment) of vertebral artery and dura mater sac as well as the surrounding bony structures of the occipital bone and also to explore the functional significance and discuss the clinical significance in hemorrhage caused by the vertebral artery rupture in operation.　Methods　Sixteen head linking neck specimens (32 sides) were selected for this investigation. The soft tissues surrounding the V3 segment of vertebral artery and the correlative connecting structure were separated. The vertebral artery-dura mater arterial ductal ligament were found and identified, their morphology and anatomical characteristics were observed. Choosing the typical vertebral artery-dura mater arterial ductal ligament to be cut into slices and stained by HE, and observed and photographed microscopically.　Results　Eleven (accounting for 43.7%) pieces of vertebral artery-dura mater arterial ductal ligament were founded among 32 sides of 16 head linking neck specimens. The longest length was 9.25 mm，the shortest was only 4.76mm. The average caliber and length were (1.16±0.15) mm and (7.39±1.33) mm respectively. The vertebral artery-dura mater arterial ductal ligament located deep to the dura meter, originated from the V3v sections and inserted either into the dura mater or into the bony structure by bifurcated several branches. The observation under light microscope showed that the histological characteristics were centrally hollow or tubular figuration, their lumen was connected with vertebral artery.　Conclusions　Vertebral artery-dura mater arterial ductal ligament is an arterial ligament connected between the V3 segment of vertebral artery and dura mater or basal part of the occipital bone. It is presented as a round tubular ligamental structure formed by occluded arterial branch arising from V3 segment of vertebral artery, it may have stationary function for V3v sections and have close relations with negative pressure formation in the cranial cavity.