尺侧腕伸肌-拇短伸肌腱移位重建拇对掌功能的应用解剖

Anatomical study for reconstruction of thumb opposition by transferring extensor carpi ulnaris to extensor pollicis brevis tendon

目的:研究拇对掌肌、拇短展肌的解剖学特点,探讨符合人体生物力学的拇对掌功能重建的方法。方法:对20侧新鲜成人上肢标本,解剖拇对掌肌、拇短展肌,并建立尺侧腕伸肌-拇短伸肌移位重建拇对掌功能的手术模型。结果:拇短展肌肌纤维方向沿第1掌骨纵轴方向,拇对掌肌肌纤维方向与第1掌骨成一定角度。尺侧腕伸肌-拇短伸肌移位后,测量拇指远侧横纹中点到第3掌骨长轴与掌远侧横纹交点之间的最大距离可达(5.9±0.7)cm。结论(:1)尺侧腕伸肌长度、肌力足以重建拇对掌功能,拇短伸肌腱止点恒定,联合移位后其作用方向与拇短展肌方向一致,且旋前角度足够。(2)以尺侧腕伸肌-拇短伸肌移位重建拇对掌功能是一种符合拇对掌功能生物力学的简单有效的方法。

Objective： To study the anatomical characteristics of opponens pollicis and abductor pollicis brevis, and to search for a method of reconstruction of thumb opposition which according with biomechanics of human thumb, Method： Opponens pollicis and abductor pollicis brevis were anatomized, and the surgery models of transferring extensor carpi ulnaris to extensor pollicis brevis tendon were set up in 20 fresh forearm specimens of adults. Result： The direction of abductor pollicis brevis was same to the axis of first metacarpal bone, but that of opponens pollicis was angled, After tendon transferred, the interval between interphalangeal joint of thumb to third metacarpophalangeal joint was （ 5.9±0.7 ）cm, Conclusions： The essentiality of opponens pollicis in thumb opposition must be understood. ECU had constant anatomical position, sufficient length and strength, The direction of transferring ECU to EPB tendon was consistent with that of abductor pollicis brevis, and the angle of thumb supination was enough to pronate. So it was a convenient and efficient procedure for reconstruction of thumb opposition by transferring ECU to EPB tendon, and it was according with biomechanics of human thumb.