自体骨—肌腱移植的解剖学研究

The anatomical study of autologous bone tendon transplant

目的 :为临床治疗垂状指及屈肌腱止点重建的新方法提供解剖学依据。方法 :对 2 0具 40侧成人尸体的跟骨 -跖肌腱、第 1掌骨—拇长展肌、第 2掌骨—桡侧腕长伸肌可行供区 ,进行止点类型、附着点面积、可切取骨块情况、以及相邻解剖结构和解剖变异等方面进行解剖学研究。并用SPSS统计软件进行统计和分析。结果。① 90 %的跖肌腱直接附着于跟骨而不与跟腱融合 (集中型占 85% ) ,止点面积为 ( 6 9.5± 4.4)mm2 ;② 93%拇长展肌腱直接附着于第 1掌骨基底部桡侧 (集中型占 87% ) ,止点面积为 ( 2 7.9± 3.4)mm2 ;③ 90 %桡侧腕长伸肌腱直接附着于第 2掌骨背侧或大于 1 /2桡背侧 (集中型占 90 % ) ,止点面积为( 31 .6± 4.2 )mm2 。切取骨块形状分为椭圆形 (平均占 1 2 % )、横形 (平均占 8% )、圆形 (平均占 7% )、弥散形(平均占 1 3% )。结论 :①跟骨—跖肌腱、部分第 1掌骨—桡侧腕长伸肌和第 2掌骨—拇长展肌的肌腱附着点形状、面积、可切取的骨块都能满足骨—肌腱移植的要求 ;②切取 3个骨—肌腱供区对手足功能无任何影响 ,为临床构制骨—肌腱移植提供了解剖学依据。

Objective:To provide anatomic evidence for the treatment of mallet finger and flexor insertion reconstruction.Methods:Anatomical study of calcaneus plantaris muscle tendon,first metacarpus long abductor m.tendon of thumb and second metacarpus long radial extensor carpal m.on 20 adult cadavers (40 sides) was made.The insertion type,attachment area,harve stable bone graft,adjacent structures and anatomical variations of these three donor regions were observed.All these data underwent statistical analysis by SPSS statistical software.Results:①90% of plantaris muscle tendons were attached directly to calcaneus instead of being attached to Achilles tendon(central type 85%),the attached area was 69.5±4.4 mm 2.②93% of long abductor m.tendons of thumb were attached directly to radial side of base of first metacarpus(central type 87%),the attached area was 27.9±3.4mm 2.③90% of long radial extensor carpal m.tendons were attached to dorsal second metacarpus of more than half or radial dorsal part of it (central type 90%),the attached area was 31.6±4.2 mm 2.The shape of bone harvested can be classified into elliptic(12%),transverse(8%),round(7%) and irregular(13%).Conclusion:①The shape,area and harvested bone of the tendon insertion of these three donor regions can meet the demand of bone tendon transplant.②The harvest of bone tendon lead to no functional damage to donor regions and these provides anatomical evidence for clinical use of bone tendon transplant.