可吸收线治疗骨性锤状指远指间关节固定针位置的解剖研究

Anatomical Study of fixing distal interphalangeal joint on treating bony mallet finger by absorption suture tying avulsion fracture fragment

目的通过测量末节手指的体表标记线与克氏针进针点的关系,为可吸收线捆扎固定撕脱骨块治疗骨性锤状指的远指间关节固定针进针点及角度、缝合线导引孔的位置提供解剖学依据。方法在16侧新鲜成人上肢标本的拇指、示指、中指、环指、小指各16根上模拟远侧指间关节的固定针(克氏针)固定,并测量进针点及进针角度。结果远侧指间关节伸0°位时,固定针宜从指体侧方进针,固定远侧指间关节的最佳进针点位于末节指骨基底部与指骨干交界处,进针角度与末节指骨中轴线成30°夹角,进针点到指远侧纹平面距离分别为:拇指13 mm、示指12 mm、中指13 mm、环指12 mm、小指11 mm。可吸收线导引孔最佳进针点在肌腱止点远端的指骨侧中线体表投影线上。结论固定针进针点以及导引孔位于上述各手指的位置时,既固定牢固、不损伤甲基质,也不影响撕脱骨片的复位。

Objective To investigate the relationship between body surface marking line of distal finger and Kirschner’s needle insertion point,and to provide anatomical basis for treating bony mallet finger by absorbable suture tying avulsion fracture fragment,including the entry point and angle of the needle for fixing distal interphalangeal joint,the position of the absorbable suture’s guiding hole.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 entry point and angle of Kirschner wire for fixing distal interphalangeal joint were measured.Bone mallet finger model group was built according to the angle between bone avulsion fracture line and the axis of the distal phalanx.Results When the distal interphalangeal joint extended at 0°,the fixation needle should be inserted from the side of the finger body.The optimal insertion point for the fixation of the distal interphalangeal joint was located at the junction of the base of the distal phalanx and the finger backbone.The included angle between insertion angle and the axis of the distal phalanx was 30°,and the distance from the insertion point to the plane of the distal phalanx of the finger was 13 mm of the thumb,12 mm of the index finger,13 mm of the middle finger,12 mm of the ring finger,and 11 mm of the little finger,respectively.The best insertion point of the absorbable guide hole was on the surface projection line of the midline lateral phalanx of the tendon insertion.Conclusions When the insertion point of the fixation needle and the guide hole are located in the positions of the above-mentioned fingers,the insertion point and the guide hole are fixed firmly,which will not damage the methyl matrix and will not affect the restoration of the avulsed bone slice.