腕关节背侧骨间韧带的解剖和生物力学研究

ANATOMICAL AND BIOMECHANICAL RESEARCH OF DORSAL WRIST INTEROSSEOUS LIGAMENTS

目的探讨部分腕关节背侧骨间韧带的解剖形态学特征,并对其力学性能进行测定,以期找到最适宜修复腕关节背侧韧带的供区。方法取8具自愿捐赠的新鲜冷冻成年男性尸体双侧腕关节标本16个,供体年龄20～38岁,身高165～178cm,双侧腕关节均未受外伤。分别观测舟月掌侧韧带(volar scapholunate ligament,SL-v)、舟月背侧韧带(dorsal scapholunate ligament,SL-d)、月三角背侧韧带(lunotriquetral ligament,LT)、小多角骨-头状骨背侧韧带(trapezoid-capitate ligament,TC)、头钩背侧韧带(capitohamate ligament,CH)以及2～4腕掌关节背侧韧带(2nd-4th carpometacarpal ligaments,CMC-2～4)的长度和厚度,并切取上述韧带的骨-韧带-骨标本,采用生物力学试验机进行韧带的拉伸力学测定,分别记录断裂强度和断裂形变,进行统计学分析。结果SL和LT呈C形,半环形分布于舟、月骨和月、三角骨的掌、背侧以及近侧;TC和CH为横形纤维,两者在头状骨背侧相互连续;CMC-2～4纤维呈纵形交叉排列。CMC-4、SL-v与TC长度比较,差异有统计学意义(P<0.05);各韧带厚度差异均无统计学意义(P>0.05)。SL-d的断裂强度最大,为(73.6±9.6)N,与其他各韧带比较差异均有统计学意义(P<0.05);SL-v的断裂形变最大,为(5.24±1.65)mm,与其他各韧带比较,差异均有统计学意义(P<0.05)。结论腕关节骨间韧带的解剖结构和生物力学特性与其生理功能密切相关,CMC-2和CH比较适宜作为修复腕关节背侧韧带的供体。

Objective To explore the anatomical features of some major dorsal wrist interosseous ligaments, and to measure their biomechanical properties to screen a suitable donor site for the repair of scapholunate dorsal ligament. Methods Sixteen wrist joints from 8 frozen fresh male adult cadavers were selected, whose age was 20-38 years and whose height was 165-178 cm. There were no injuries to their wrists. The follow ligaments were observed and measured for the interosseous ligaments： volar and dorsal scapholunate ligaments （SL-v, SL-d）, lunotriquetral dorsal ligament （LT）, trapezoid- capitate dorsal ligament （TC）, capitohamate ligament （CH） and the 2nd-4th carpometacarpal ligaments （CMC-2-4）. The bone-ligament-bone samples of the above ligaments were prepared for further biomechanical measurements. Ligament extension testing was performed for each bone-ligament-bone sample on a material testing system. The broken load and length were measured and statistically analyzed. Results The SL and the LT were both ＂C＂ shape, attaching to the volar, proximal and dorsal joint surface. The TC and CH ligaments were mainly transverse fibers, which connected with each other at the dorsal side of capitate. The CMC-2-4 ligaments were obliquitous fibers. Within these wrist interosseous ligaments, the SL-v and CMC-4 were relatively long. The ligament length differences were significant between SL-v and TC and between CMC-4 and TC （P 〈 0.05）. TC and CMC-2 were fairly thick. But there was no significant difference among the ligaments （P 〉 0.05）. SL-d had the highest broken load of （73.6 ± 9.6） N. The broken load differences were all significant between SL-d and other ligaments （P 〈 0.05）. SL-v had largest broken length of （5.24 ± 1.65） mm. The broken length differences were all significant between SL-v and other ligaments （P 〈 0.05）. Conclusion The anatomical structures and biomechanical features of the wrist interosseous ligaments were closely related with their physiological functions. CMC-2 and CH are both suitable to be used for the repair of scapholunate dorsal ligament.