舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

The role of SLIL in 3D movement of scaphoid and lunate during wrist radio-ulnar deviation

目的观察在腕关节尺桡偏运动时，舟月骨问韧带（scapholunate interosseous ligament，SLIL）及其各亚区分级切断后对舟骨与月骨三维运动的影响，从亚区水平对SLIL在舟月骨三维运动中的作用进行研究。方法取12例新鲜冰冻成人上肢标本（左、右侧各6例），共分为正常对照组、断SLIL近侧组、断SLIL近＋背侧组、断SLIL近＋掌侧组、SLIL全断组（每组6例）。采用三维激光扫描及图像重建技术，测定在腕关节尺桡偏时舟骨与月骨的三维运动数据，并进行统计学处理。结果在正常腕关节做尺桡偏运动时，舟、月骨同时也做尺桡偏运动，但还伴有明显的屈伸方向上的运动；与此同时，舟、月骨还做一定的旋前、旋后活动。在切断近＋掌和近＋背侧亚区组，舟月骨的活动受到影响。全切断SLIL会导致舟骨掌屈度增加，月骨掌屈活动减弱。结论采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度，从SLIL亚区水平上进行的研究表明，部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响，但SEIL近侧亚区在控制舟、月骨的活动上不起主要作用。

Objective To observe the effects of transection of scapholunate interosseous ligament （SLIL） and its subregions on the 3D movement of scaphoid and hmate during wrist radio-tdnar deviation, and study the role of SLIL subregions in 3D motion of the scaphoid and lunate. Methods Twelve fresh adult cadaver upper extremities （6 left side and 6 right side） were divided to normal control group, proximal SLIL subregion transection group, proximal and dorsal SLIL subregion transection group, proximal and palmar SLIL subregion transection group and entire SLIL transection group （6 each）. 3D laser scanning and reconstruction techniques were applied to measure 3D motion of the scaphoid and lunate during wrist radio-ulnar deviation, and data were statistically analyzed, on the normal and sequential sectioning of SLIL subregions during wrist flexion-extenslon and wrist radial-ulnar deviation were determined. Results In the intact wrist specimens, the scaphoid and lunate deviated radially and ulnarly during wrist radial-ulnar deviation, along with obvious flexion and extension. At the same time, there was minimal scaphoid and lunate pronation-supination. With sectioning of proximal subregious of the SLIL, no significant kinematics changes were observed in the scaphoid and lunate bones. After sectioning proximal and palmar or proximal and dorsal subregions of the SLIL, kinematics of the scaphoid and lunate were changed. Sectioning the whole SLIL caused increased volar flexion of the scaphoid and decreased volar flexion of the lunate. Condu^on 3D laser scanning and reconstruction can precisely measure 3D motion of the scaphoid and lunate. Kinematic study of SLIL subregions showed that partial or complete sectioning of SLIL led to obvious change in volar flexion of the scaphoid and lunate. However, the proximal subregion of SLIL has no prominent effect on the motion of scaphoid and lunate.