末节指骨截骨延长相关解剖研究

Relative anatomic research on distal phalanx lengthening

[目的]通过对末节指骨进行解剖、测量分析,探讨末节指骨延长的适宜截骨部位及末节指骨残端的外观重建方法。[方法]2013年10月~2015年1月,收集成人完整前臂标本30例,灌注红色乳胶并低温保存固定。经甲板、甲床、指腹依次分离暴露末节指骨及其支配血管,并进行测量,具体内容有:测量末节指骨全长,甲板长度,甲根长度;关节面距伸肌腱止点距离,伸肌腱止点距甲基质距离,甲基质长度,甲基质远端距指骨远端距离;远指间关节面距屈肌腱止点距离,关节面距滋养动脉入骨点的距离。采用SPSS 18.0软件包对测量数据进行统计学分析。[结果]拇指:全长为(26.58±1.13)mm,指间关节面距伸肌腱止点距离(6.34±1.15)mm,伸肌腱止点距甲基质距离(3.25±0.24)mm,甲基质长度(5.93±1.41)mm,甲基质远端距指骨远端距离(11.12±0.56)mm,甲根长度为(4.83±0.14)mm,甲板总长度(16.98±0.50)mm,关节面距屈肌腱止点距离(12.68±0.61)mm,关节面距滋养动脉入骨点的距离(16.51±2.64)mm。手指:全长为(18.63±1.32)mm,关节面距伸肌腱止点距离(1.94±0.25)mm,伸肌腱止点距甲基质距离(1.77±0.49)mm,甲基质长度(5.34±1.19)mm,甲基质远端距指骨远端距离(9.38±0.93)mm,甲根长度为(4.67±0.20)mm,甲板总长度(14.91±0.95)mm,关节面距屈肌腱止点距离(7.65±0.81)mm,关节面距滋养动脉入骨点的距离(11.24±1.56)mm。[结论]远节指骨基底是末节指骨延长的适宜部位。

[Objective] To explore a suitable osteotomy site in distal phalanx lengthening for reconstruction of the rem- nant finger by anatomic observation. [Methods] A total of 30 amputated adult forearms which were collected from October 2013 to January 2015 were perfused with red latex, fixed and stored at low temperature. The samples were dissected to expose the bone of distal phalanx and its nutrient blood vessels. Anatomic parameters were measured. A statistical analysis was performed using SPSS19.0 software package. [Results] Thumbs parameters were documented as follows： 26.58±1.13 mm in the total length, 6.34±1.15 mm in distance of distal interphalangeal to insertion of extensor tendon, 3.25±0.24 mm in distance of matrix to insertion of extensor tendon, 5.93±1.41 mm in length of matrix, 11.12±0.56 mm in distance of distal end of matrix to distal end of phalanx, 4.83±0.14 mm in length of nail plate under eponychium, 16.98±0.50 mm in length of nail plate, 12.68±0.61 mm in distance of distal interphalangeal to insertion of flexor tendon, and 16.51±2.64 mm in distance of distal interphalangeal to nutrient artery. By contrast, fingers, the total length was 18.63±1.32 mm, 1.94±0.25 mm for distance of distal interphalangeal to insertion of extensor tendon, 1.77±0.49 mm for distance of matrix to insertion of extensor tendon, 5.34±1.19 mm for length of matrix, 9.38±0.93 mm for distal end of matrix to distal end of phalanx, 4.67±0.20 mm for length of nail plate under eponychium, 14.91±0.95 mm for length of nail plate, 7.65±0.81 mm for distance of distal interphalangeal to insertion of flexor tendon, and 11.24±1.56 mm for distance of distal interphalangeal to nutrient artery. [Conclusions] The base of distal phalanx is the best osteotomy site for distal phalanx lengthening.