桡侧腕短伸肌腱移位拇长伸肌腱重建伸拇功能的应用解剖

Extensor carpi radialis brevis transfer to extensor pollicis longus ：an anatomical study

目的研究桡侧腕短伸肌腱移位拇长伸肌腱重建伸拇功能的解剖学基础。方法对12侧新鲜成人尸体上肢标本的桡侧腕短伸肌和拇长伸肌进行应用解剖学参数的测量；建立以桡侧腕短伸肌为动力肌移位至拇长伸肌腱的解剖模型．并对比重建的拇长伸肌腱解剖学变化。结果桡侧腕短伸肌腱的有效移位长度为（3．5±0．8）cm：桡侧腕短伸肌和拇长伸肌肌腹的最大周径分别为（8．5±0．8）cm、（3．6±0．3）cm，肌肉横截面积比为5．57：解剖模型建立后拇长伸肌腱的走行角度为（30±7）°，与术前的走行角度（50±9）°相比，相差（20±5）°，差异有统计学意义（P〈0．05）；拇指的伸展角度为（50±12）°与术前的走行角度（58＋160）相比相差（8±3）°；第一掌骨背伸角度为（12±5）°，与术前（15±80）相比，减少了（3±2）°；拇指指尖抬升高度为（2．3±0．9）cm，与术前（3．5±1．2）cm相比，降低了（1．2±0．6）cm，以上差异均无统计学意义（P〉0．05）。结论通过测量、对比桡侧腕短伸肌和拇长伸肌的解剖学参数．证实桡侧腕短伸肌具有足够的肌力、长度重建拇长伸肌的功能；以桡侧腕短伸肌重建伸拇功能解剖模型建立后，具有良好的伸拇外观。符合解剖及生物力学规律。这为临床的进一步应用提供解剖学依据。

Objective To investigate the anatomical basic of extensor carpi radialis brevis （ECRB） tendon transferring to extensor pollicis longus （EPL） tendon. Methods Twelve sides of ECRB and EPL in fresh aduh cadaver＇s forearms were collected, and the anatomical model of ECRB transferring to EPL was set up in all the forearms. The anatomical parameters of EPL were measured before and after anatomical model established. Results The effec- tive transferring length of ECRB was （3.5±0.8）cm; the maximum circumferential of ECRB and EPL were （8.5±0.8）cm and （3.6±0.3）cm （P 〉0.05）, the ratio of muscle cross-sectional area was 5.57; After the anatomical model setting up, anatomic angles of EPL was （30±7）°, which was a decrease of （20±5）° comparing with the preoperative angel of （50±9） ° （P 〉0.05 ）; Thumb extension angle was （50± 12）°, which was a decrease of （8±3）° comparing with the preoperative angel of （58 ±16） ° （P〈0.05）; The dorsal extension angle of first metacarpal was （12±5 ）°, which was a decrease of （3± 2） ° comparing with the preoperative angle （15±8） ° （P〉0.05）; Thumb tip lifting height was （2.3±0.9） cm, which was a decrease of （1.2±0.6）cm comparing with the preoperative height （3.5±1.2）cm （P 〉0.05）. Conclusion Based on the measurement of the anatomic parameters of ECRB and EPL, the ECRB has enough length and muscle force to recon- struct the function of EPL. The thumb had a good extension appearance and accorded with the rule of biomechanics af- ter setting up the anatomical model of ECRB transferring to EPL. This study will provide the anatomical evidence for further clinical application