近侧列腕骨间关节及韧带的应用解剖学观察

The applied anatomy of proximal midcarpal joints and ligaments

目的对近侧列腕骨间关节及部分腕部韧带的解剖组织学特性进行详细观察。方法对成人腕关节标本的近侧列腕骨间关节及部分韧带进行解剖学观察、测量,并进行组织学观察。结果舟月及月三角骨间韧带各亚区中,近侧亚区最薄弱,掌、背侧亚区较粗壮。小多角骨-第2掌骨间背侧韧带长(3.13±0.28)mm,宽(9.12±0.35)mm,厚(3.28±0.25)mm,头状骨-第3掌骨间背侧韧带长(3.45±0.15)mm,宽(11.87±0.44)mm,厚(3.03±0.29)mm。舟月骨间韧带(SLIL)掌、背侧亚区韧带纤维间含较多血管神经束,近侧亚区则为乏血管区;SLIL与月三角骨间韧带(LTIL)有较高的穿孔率。结论小多角骨-第2掌骨间背侧韧带及头状骨-第3掌骨间背侧韧带均可作为舟月骨间韧带背侧亚区重建的供区材料;SLIL及LTIL按组织结构及形态可分为掌、背、近侧3个亚区;SLIL及LTIL较高的穿孔率表明腕关节造影术不能准确判断关节内韧带是否损伤。

Objective To observe and measure the anatomic properties of midcarpal articulation and partial carpal ligaments.Methods Sixty upper limb specimens from adult cadavers were used in this investigation.All dissections were carried out under room temperature.Scapholunate interosseous ligament（SLIL） were stained with hematoxylin and eosin and viewed under standard optic microscopy.Results The dorsal and palmar subregions of SLIL and lunotriquetral interosseous ligament（LTIL） were stronger than the proximal subregion.The length,width and thickness of the dorsal trapezoid-to-second metacarpal ligaments was about（3.13±0.28） mm,（9.12±0.35） mm and（3.28±0.25）mm averagely,and that of dorsal capitate-to-third metacarpal ligaments was about（3.45±0.15）mm,（11.87±0.44）mm and（3.03±0.29）mm respectively.Both ligaments could match the size of dorsal SLIL by adequate modification.The histological observation showed the different features between proximal SLIL subregion and dorsal（palmar） subregion.The perforation ratio of SLIL and LTIL in formalin-fixed specimens was higher than that in fresh-frozen specimens obviously.Conclusions The morphologic features of bone,ligament and joints in wrist are complicated.Anatomically,the SLIL are composed of three discrete regions： dorsal,proximal,and palmar.The SLIL are composed of true ligaments dorsally and palmary,as defined by histological studies.Because of the high perforation ratio of SLIL and LTIL,arthrography cannot give accurate information concerning the ligament tear in some case.