【摘要】： 目的 研究拇指第一腕掌關(guān)節(jié)周圍韌帶的走行、毗鄰、形態(tài)及結(jié)構(gòu)特點(diǎn),探討拇指第一腕掌關(guān)節(jié)橈背側(cè)脫位的解剖學(xué)基礎(chǔ),為臨床診斷和處理提供解剖學(xué)依據(jù)。 方法 12例國人成年男性尸體手作為解剖標(biāo)本,經(jīng)X線平片檢測每一標(biāo)本都不存在解剖變異,骨性關(guān)節(jié)炎表現(xiàn)。對于隨機(jī)、性別和優(yōu)勢手上的差異沒有予以考慮。分別從拇指腕掌關(guān)節(jié)的背側(cè)和掌側(cè)仔細(xì)地切除皮膚,皮下組織,切除大魚際肌,顯露關(guān)節(jié)囊,在解剖韌帶之前全面觀察關(guān)節(jié)囊。在2.5倍手術(shù)放大鏡下進(jìn)行解剖觀察,觀察了拇指第一腕掌關(guān)節(jié)周圍5條韌帶的走行、比鄰和形態(tài)結(jié)構(gòu)特點(diǎn),研究了構(gòu)成第一腕掌關(guān)節(jié)骨的形態(tài)學(xué)特點(diǎn),用游標(biāo)卡尺(精確度為0.01mm)測量各組韌帶在正常(中立位)狀態(tài)下的長度(韌帶的起止點(diǎn)間的距離)及最大拉伸長度,取每條韌帶的中點(diǎn)測量其寬度和厚度在最大屈曲位,背伸位、內(nèi)收位、外展位狀態(tài)下,用游標(biāo)卡尺測量韌帶的長度。所得的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理(以(?)±S)。對后斜韌帶及橈背側(cè)韌帶的相關(guān)力學(xué)進(jìn)行了測量。 結(jié)果 拇指第一腕掌關(guān)節(jié)的韌帶組成復(fù)雜,其周圍韌帶的構(gòu)成有以下五種即:前斜韌帶、后斜韌帶、橈背側(cè)韌帶、尺側(cè)副韌帶與第一掌骨間韌帶。觀察五組韌帶,關(guān)節(jié)背側(cè)韌帶較為肥厚,粗大。比較背斜韌帶與橈背側(cè)韌帶的力學(xué)時(shí)發(fā)現(xiàn):橈背側(cè)韌帶與后斜韌帶在穩(wěn)定拇指第一腕掌關(guān)節(jié)背側(cè)作用無明顯的差異,但橈背側(cè)韌帶在穩(wěn)定拇指第一腕掌關(guān)節(jié)橈側(cè)作用大于后斜韌帶。 結(jié)論 拇指第一腕掌關(guān)節(jié)周圍的韌帶中,背側(cè)韌帶厚而緊張。橈背側(cè)韌帶在阻止拇指第一腕掌關(guān)節(jié)橈背側(cè)脫位的作用要強(qiáng)于后斜韌帶。在臨床工作中應(yīng)注重橈背側(cè)韌帶的修復(fù)。
[Abstract]:Objective to explore the anatomic basis of the first metacarpophalangeal joint of the thumb in the radial dorsal dislocation of the first metacarpal joint of the thumb, and to provide anatomic basis for clinical diagnosis and management. Methods 12 Chinese adult male cadavers were taken as anatomical specimens. No anatomic variation was found in each specimen by X ray plain film, and osteoarthritis was found. Random, gender and dominance differences were not taken into account. The skin and subcutaneous tissue were excised from the dorsal and palmar sides of the metacarpophalangeal joint of the thumb respectively. The hypothenar muscles were excised and the articular capsule was exposed. The articular capsule was observed before anatomic ligaments. Anatomic observation was carried out under a 2.5 times operating magnifying glass. The running, adjacent and morphological characteristics of the five ligaments around the first metacarpal joint of the thumb were observed, and the morphological characteristics of the bone forming the first carpometacarpal joint were studied. Vernier caliper (accuracy of 0.01mm) was used to measure the length of the ligaments in normal (neutral position) state (the distance between the starting and ending points of the ligaments) and the maximum stretch length. The width and thickness of the ligaments were measured at the maximum flexion position at the midpoint of each ligament. Measure the length of ligaments with Vernier calipers in the position of extension, adduction, and display. The obtained data were statistically processed (in the form of (?) 鹵S). The mechanics of posterior oblique ligament and dorsal radial ligament were measured. Results the ligaments of the first carpometacarpal joint of the thumb were complicated, and there were five kinds of ligaments around them: anterior oblique ligament, posterior oblique ligament, dorsal radial ligament, ulnar collateral ligament and first metacarpal ligament. Observation of the five groups of ligaments, joint dorsal ligament is thicker, thicker. When comparing the mechanics of the anticlinal ligament with the dorsal radial ligament, it was found that there was no significant difference between the radial dorsal ligament and the posterior oblique ligament in stabilizing the dorsal side of the first metacarpal joint of the thumb. But the radial dorsal ligament was more effective in stabilizing the first carpometacarpal joint of the thumb than the posterior oblique ligament. Conclusion in the ligaments around the first metacarpal joint of the thumb, the dorsal ligament is thick and tense. The radial dorsal ligament is stronger than the posterior oblique ligament in preventing the first metacarpal joint of the thumb. Attention should be paid to the repair of dorsal radial ligament in clinical work.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R684;R322;R318.01

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