可吸收线治疗骨性锤状指皮肤切口的解剖研究

Clinical anatomical study of skin incision on treating bony mallet finger by absorption suture tying avulsion fracture fragment

目的通过测量末节手指,为可吸收线治疗骨性锤状指手术皮肤切口设计提供解剖学依据。方法随机选取16侧新鲜成人上肢标本,拇指、示指、中指、环指和小指各16根。测量指伸肌腱止点到指远侧纹指背投影线的距离、甲基质近端到肌腱止点远端的距离、肌腱止点处的宽度,确定皮肤切口的长度和宽度。结果(1)肌腱止点宽度:拇指(10.72±0.42)mm,示指(6.14±0.33)mm,中指(6.73±0.39)mm,环指(5.63±0.37)mm,小指(4.64±0.38)mm;(2)肌腱止点到甲基质近端距离:拇指(1.53±0.12)mm,示指(1.46±0.08)mm,中指(1.48±0.07)mm,环指(1.42±0.07)mm,小指(1.42±0.08)mm;(3)肌腱止点到指远侧纹指背投影线距离:拇指(6.12±0.55)mm,示指(5.03±0.36)mm,中指(5.15±0.32)mm,环指(4.89±0.36)mm,小指(4.02±0.24)mm。结论用可吸收线捆扎固定撕脱骨块治疗骨性锤状指时在末节指背行"U"形切口,远端不宜超过甲基质近端,切口两侧宽度应越过肌腱止点各2.00 mm,既不影响血供也能充分暴露术野。

Objective To provide anatomical basis for treating bony mallet finger by absorbable suture tying avulsion fracture fragment.Methods 16 fresh adult upper limb specimens were randomly selected,including 16 thumbs,16 index fingers,16 middle fingers,16 ring fingers and 16 little fingers.The important structures of distal phalanx were observed.The distance from the extensor terminal tendon to rear projection line of the distal finger grain and the distance from nail matrix proximal end to the distal tendon terminal and the width of the tendon terminal were measured to design suitable length and width for skin incision.Results(1)Tendon insertion width were as follow:thumb(10.72±0.42)mm,index finger(6.14±0.33)mm,middle finger(6.73±0.39)mm,ring finger(5.63±0.37)mm,little finger(4.64±0.38)mm,respectively;(2)proximal distance between tendon insertion and nail matrix were as follow:thumb(1.53±0.12)mm,index finger(1.46±0.08)mm,middle finger(1.48±0.07)mm,ring finger:(1.42±0.07)mm,little finger(1.42±0.08)mm;(3)the distance between the tendon insertion point and the dorsal projection line of the distal finger:thumb(6.12±0.55)mm;index finger(5.03±0.36)mm;middle finger(5.15±0.32)mm;ring finger(4.89±0.36)mm;little finger(4.02±0.24)mm.Conclusions When treat bony mallet finger by absorbable suture tying avulsion fracture fragment,we should perform U-shape incision at the distal interphalangeal joint,start from the streakline on the palm side.The width of the incision is 2.0 mm across the tendon insertion,which will not affect the blood supply and can fully expose the operative field.