钩骨腕掌关节移位重建指骨间关节的解剖学基础研究

Anatomical basis for the hamatum displacement of the carpometacarpal joint and reconstruction of the interphalangeal joint

目的探讨钩骨腕掌关节移位、修复和重建手的功能性关节的解剖学基础。方法22侧冷冻成人手腕标本,解剖观测钩骨腕掌关节和中节指骨基底关节面的形态、结构特点,测量各关节面的尺桡径、掌背径、关节面凹面的深度及关节面面积。将所得数据进行统计分析,比较钩骨腕掌关节和中节指骨基底关节面在形态、结构特点、面积及各径线长度的相似度。结果钩骨腕掌关节的尺桡径(13.54mm±1.15mm,钩骨腕掌关节尺桡侧缘中点的距离)和示、中、环指中节与拇指远节指骨基底关节面的尺桡径(关节面尺桡侧缘中点的距离)无统计学差异(P>0.01,对应t值分别为2.7670、-2.0720、2.1608、1.2189);钩骨腕掌关节的掌背径(10.71mm±0.93mm,钩骨底嵴的两顶点间距离)和环指中节指骨基底关节面的掌背径(关节面掌背侧缘中点的距离)无统计学差异(P>0.01,t=1.6170);钩骨腕掌关节的尺侧凹面深度(1.30±0.08)mm、桡侧凹面深度(0.95±0.05)mm、面积(139.89±5.44)mm2和示、中、环、小指中节指骨、拇指远节指骨基底关节面的凹面深度(尺、桡侧关节面掌背缘中点为支点测量深度)及面积有统计学差异(P<0.01)。结论钩骨腕掌关节可作为一个新的良好关节供区,用于修复和重建各中节指骨基底关节面。

Objective To study the anatomic basis of the repair and reconstruction of hand joint using transposition of the carpometacarpal （CMC） joint of the hamatum. Methods The morphous and structure of the CMC joints of the hamatum and the base joints of the middle phalanx were observed on the 22 freshly frozen wrist specimens. The volar dorsal dia、radiounar dia, depth of convave and area of the joints were measured. The data were got statistical analysis, the resemblance of the joints were compared on the morphous, structure, area and length of diameter. Results The radiounar dia of the CMC joints of the hamatum was （13.54±1.15） mm , and there was not evident difference in the middle phalanx of forefinger, middle finger, ring finger and the distal phalanx of thumb. The volar dorsal dia of the CMC joints of the hamatum was （10.71±0.93） mm, there was evident difference in the middle phalanx of ring fingers. The depth of ulnar and radial convave of the CMC joints of the hamatum was （1.30±0.08） mm, （0.95±0.05） mm respectively, and the area of the CMC joints of the hamatum was （139.89±5.44） mm2. There was evident difference in the all fingers. Conclusions The CMC joint of the hamatum could be looked as a new and well joint donor site. It could be used to repair and reconstruct the base joints of the middle phalanx.