针刀经皮松解屈指肌腱A1滑车的局部解剖学研究

Anatomic study of percutaneous release of A1 pulley

目的:研究针刀经皮松解A1滑车的进针穿刺路径及毗邻神经血管组织的解剖学。方法:选取人体上肢标本84只(男54只、女30只;左手40只、右手44只),标记手指指面正中线,于掌指关节处由浅至深逐层解剖分离软组织,观察解剖层次并测量相关解剖数据。结果:A1滑车的长度(L)为7.86±2.62mm,宽度(W)为5.59±1.47mm;大拇指A1滑车近心端距掌指关节横纹处的距离(D1)0.21±0.83mm,余四指D1平均9.35±3.62mm;食指A1滑车近心端距掌中横纹的距离(D2)为7.59±2.88mm,中指、环指、小拇指D2平均8.07±3.34mm。指面正中线的在A1滑车表面投影线距桡侧指固有神经的距离(D3)5.11±1.39mm,距尺侧指固有神经的距离(D4)为5.47±1.64mm。结论:经皮松解A1滑车的进针点在指面正中线上,大拇指以掌指关节横纹为参考,食指以掌中横纹为参考,中指、环指、小拇指以远端掌横纹为参考,其松解长度不宜>9mm,进针方向与正中线平行。

Objective:To explore the anatomical basis of the puncture path of percutaneous release of A1 pulley and its adjacent nerve and blood vessel tissues.Methods:Cadavers including 84 human upper limb specimens with formalin fixation(54 males,30 females;40 left-sided and 44 right-sided),with an average age of 82.60±12.46 years.Label the median line of the finger and dissect the soft tissue layer by layer at the metacarpophalangeal joint from shallow to deep.Results:The average length(L)of A1 pulleys was 7.86±2.62 mm;the average width(W)of A1 pulleys was 5.59±1.47 mm;the average distance(D1)between the proximal ends of A1 pulley of thumbs and the transverse lines of metacarpophalangeal joints was 0.21±0.83 mm,and that of the other four fingers was 9.35±3.62 mm;the average distance(D2)between the proximal ends of A1 pulleys of index fingers and the transverse striae of middle palms was 7.59±2.88 mm,and that of middle fingers,ring fingers and little fingers was 8.07±3.34 mm;the average distance between the projection lines of finger midlines on A1 pulley surface and the radial side of innate digital nerve(D3)was 5.11±1.39 mm;and the average distance between the projection lines of finger midlines on A1 pulley surface and the ulnar side of innate digital nerves(D4)was 5.47±1.64 mm.Conclusion:The position of puncture point for percutaneous release of A1 pulley is located on the midline line of fingers.The thumb refers to the transverse lines of metacarpophalangeal joints;the index finger refers to the transverse stria of middle palm;while the middle finger,ring finger and little finger refer to the transverse lines of middle palm.The release length should not exceeds 9 mm,the needling direction is parallel to the midline line of fingers.