手舟月骨间韧带和月三角骨间韧带的解剖学特点

Anatomic features of scapholunate and lunotriquetral interosseous ligaments of the wrist

背景:国内外已对舟月骨间韧带和月三角骨间韧带做过一些解剖学、组织学及生物力学特性的研究,尚缺乏对韧带的长、宽、厚的形态学测量。目的:探讨手舟骨、月骨与三角骨间的舟月骨间韧带和月三角骨间韧带的解剖学特性及作用。设计、时间及地点:重复测量设计实验,于2008-02/12在湖南省永州职业技术学院医学院解剖教研室完成。材料:38侧成人尸体手标本,其中34侧为甲醛固定标本,另4侧为新鲜标本。方法:去除腕掌背侧的皮肤,皮下组织,切断腕横韧带,在掌侧正对桡腕关节的腕关节囊上作弧形切口,从桡骨茎突处至桡尺远侧关节处切开桡腕关节,在5倍解剖放大镜下,解剖并观察舟月骨间韧带和月三角骨间韧带的起止走行及与关节囊韧带的联系,测量两韧带在不同附着部位的长度。最后将两韧带逐一切断,观察它们在舟骨、月骨和三角骨相对关节面上的附着宽度。并在韧带的中段测量其宽度和厚度。在切断两韧带时,先近侧部,再掌背侧部,了解切断后对舟月骨关节和月三角关节的稳定性影响。主要观察指标:舟月骨间韧带和月三角骨间韧带在背侧部、掌侧部和近侧部的长度、宽度和厚度。结果:舟月骨间韧带位于舟、月骨相对关节面之间,连接关节面的掌侧缘、近侧缘和背侧缘。月三角骨间韧带连接于月骨和三角骨相邻的掌侧、背侧和近侧边缘。两韧带分为背侧、掌侧和近侧3个部分,其掌背侧部以致密纤维结构为主,但近侧部显示有纤维软骨样成分。舟月骨间韧带和月三角骨间韧带在掌侧部的长度、宽度和厚度都较相近;在背侧部舟月骨间韧带的长度较长、宽度较宽,厚度明显厚于月三角骨间韧带;在近侧部两韧带长度和厚度相差较大。两韧带在掌侧部、近侧部和背侧部的宽度基本接近。月骨间韧带和月三角骨间韧带的近侧部切断后,舟月关节和月三角关节稳定性未受到明显影响,再切断掌背侧部,舟月骨间关节和月三角关节稳定性受影响。结论:舟月骨间韧带和月三角骨间韧带结构特殊,对舟骨、月骨与三角骨及骨间关节起稳定性作用。

BACKGROUND： Some studies have been made to scapholunate interosseous ligament （SLIL） and lunotriquetral interosseous ligament （LTIL） in terms of their anatomic, histological and biological features both at home and abroad. But there is still a lack of morphologic measurements in regard to the length, the width and the thickness of the ligaments. OBJECTIVE： To explore anatomic features and roles of SLIL and LTIL located among the scaphoid bone, the lunate bone and the triquetral bone. DESIGN, TIME AND SETTING： A repeated measurement design experiment was performed in Department of Anatomy, Mecical College of Yongzhou Vocational-Technical College between February and December in 2008. MATERIALS： Thirty-eight adult wrist specimens from cadavers were prepared for the study, of which 34 ones were fixed in formalin, and the other 4 ones were fresh. METHODS： First, specimens received a series of operations as follows： removeing skins and subcutaneous tissues, cutting off transverse carpal ligaments, making arc incisions to joint capsules at palmar parts of wrist joints, opening wrist joints from styloid processes of radius to distal radioulnar joints. Then they were dissected and observed under 5-fold anatomic microscope to find the origination, insertion, course of SLIL and LTIL as well as their spatial relationship with carpal ligaments, and to measure the length of the two kinds of ligaments at different adherent parts. Finally, the two kinds of ligaments were cut off to observe their attaching width on articular surfaces of scaphoid bones, lunate bones and triquetral bones, and to measure their width and thickness in middle parts. In addition, to oberve the effect of cutting off them on the stability of scapholunate joints and lunotriquetral joints, the two ligaments were cut off at proximal parts first, and then came dorsal parts and palmar parts. MAIN OUTCOME MEASURES： The length, width and thickness of SLIL and LTIL at dorsal part, palmar part and proximal part. RESULTS： The SLIL located between scaphoid bone surface and lunate bone surface, connecting palmar lateral margin, proximal lateral margin and dorsal lateral margin of the articular surface. The LTIL connected palmar lateral margin, proximal lateral margin and dorsal lateral margin neighboring to lunate bone and triquetral bone. The two ligaments were composed of three parts： dorsal part, palmar part and proximal part. The palmar part and dorsal part were mainly composed of compact connective tissues, and fibrocartilages were found in proximal part. Moreover, the SLIL and LTIL had similar length, width and thickness at palmar parts. But at dorsal parts, the SLIL was longer, wider and significantly thicker than the LTIL. At proximal part, there were significant differences in the length and thickness between SLIL and LTIL. The SLIL and LTIL had similar width at dorsal part, palmar part and proximal part. In addition, the stability of scapholunate joint and lunotriquetral joint was not significantly influenced until the two ligaments were cut off at dorsal and palmar part. CONCLUSION： The SLIL and LTIL have special structures and are the key structures for stability of scaphoid bones, lunate bones, triquetral bones and interosseous ligaments.