桡骨茎突的解剖学观察及其在针刀治疗腱鞘炎中的临床意义

Anatomical observation of styloid process of radius and its clinical significance in the treatment of tenosynovitis with acupotomy

目的:研究桡骨茎突部的解剖结构及其对针刀治疗桡骨茎突狭窄性腱鞘炎产生的影响。方法:选取59例用10%福尔马林防腐固定的成人前臂标本,标本来源于北京大学基础医学院遗体捐献中心,研究时间为2017年11月~2018年5月。在人体标本上模拟针刀松解桡骨茎突部第一骨性纤维鞘管操作,测量并观察伸肌支持带的解剖变异、桡骨茎突骨槽,纤维间隔情况及肌腱斜行角度。结果:19例(32.20%)存在纤维间隔,6例存在完全纤维间隔、长度伴随整个肌腱延伸,13例为不完全纤维间隔、长度为6.78±2.91mm(2.45~10.88mm)。有纤维间隔的标本中,仅有2例(10.52%)的针刀操作对2个纤维间隔同时进行了松解。40例上肢标本中,12例(30%)在桡骨茎突骨沟内有骨嵴。骨嵴长度5.71~14.60mm,宽度1.84~3.51mm,高度1.0~3.03mm。拇长展肌腱与拇短伸肌腱在桡骨茎突处呈15.8°±4.13°(7°~23°)斜行。结论:腕第一腔室纤维间隔、桡骨茎突骨槽内骨嵴会增加桡骨茎突狭窄性腱鞘炎的发病几率及治疗难度,拇长展肌腱与拇短伸肌腱在桡骨茎突处斜行应注意其角度,防止推割中的损伤。

Objective:To study the anatomical structure of styloid process of radius and its effect on the treatment of acupotomy.Methods:Fifty-nine adult forearm specimens fixed with 10% formalin were used.The specimens were derived from the Donor Center of School of Basic Medical Sciences,Peking University.The research period was from Nov.2017 to May 2018.Performing a simulated acupotomy release of the No.1 osteofibrous canal of radius styloid process,measuring and observing the anatomical variation of the extensor retinaculum,bone groove,chamber septum and the oblique angle of the tendon.Results:32.20%(19/59)had chamber septum,6 cases were with complete length,and 13 cases had incomplete length of 6.78±2.91 mm.Only 10.52%(2/19)of the acupotomy operation released two chamber spaces.Of the 40 upper limbs,12 had bony prominences in the bone groove,and the incidence of bony prominence was 30%.The length of the bony prominences is 5.71-14.60 mm,the width is 1.84-3.51 mm,and the height is 1.0-3.03 mm.The tendon were inclined at 15.8±4.13°.Conclusion:The chamber septum and the bony prominence in styloid process of radius can increase the incidence of tenosynovitis and the difficulty of treatment.The angle of the abductor longus and the extensor tendon should be observed at the styloid process of radius to reduce damage during operation.