近指间关节掌板的解剖研究及临床意义

The anatomical study of proximal interphalangeal joint volar plate and its clinical significance

目的了解近指间关节掌板及其韧带的解剖结构并进行模拟试验，分析掌板各条韧带的作用，探讨近指间关节屈曲挛缩的原因及治疗方案。方法选取成人新鲜尸体除拇指外的断指标本共16指，8指用于观察掌板及韧带的解剖结构及运动复位情况；另8指用于模拟实验，分别切断掌板的不同韧带，观察掌板运动情况，以此分析各条韧带的具体作用。结果在屈指过程中，掌板的移动主要是依靠中节指骨底掌侧唇的推动作用，远端连接韧带是伸指过程中牵拉掌板复位的主要动力源。两条Check—Rein韧带对掌板的运动几乎不起作用。两边的副韧带将掌板限制于关节滑车内，靠自身的伸缩作用对掌板运动产生一定影响。侧副韧带是保持近指问关节稳定的主要因素。结论当掌板远端损伤时，副韧带的挛缩使掌板固定在半脱位状态。如何恢复副韧带的弹性是治疗近指问关节屈曲挛缩的关键。

Objective To study the anatomy of the volar plate and ligaments of the proximal interphalangeal （PIP） joint and explore the etiology and treatment of PIP joint flexion contracture. Methods Sixteen fresh cadaver finger specimens were dissected. The anatomy and movement relationship of the volar plate and ligaments of the PIP joint were observed in 8 specimens. The other 8 specimens were used for simulation to cut different ligaments and observe movement of the volar plate, and analysis the real fi.mction of each ligament. Results In finger flexion the bottom of the middle phalanx pushed the volar plate to the proximal side. The distal ligament of the volar plate was the main force to pull the volar plate back in place during finger extensor. The two Check-Rein ligaments almost had no effect to the movement of the volar plate. The two collateral ligaments restricted the volar plate on the trochlea of the phalanx, and moderately influenced the movement of the volar plate. The collateral ligament was the main mechanism to maintain stability of the proximal interphalangeal joint. Conclusion When the distal volar plate is injured, contracture of the collateral ligament fixes the volar plate in subluxation. Restoring flexibility of the collateral ligament is the key to treating flexion contracture of the proximal interphalangeal joint.