第2～5掌指关节及其附属结构的解剖和临床意义  

The anatomy and clinical significance of the 2nd～5th metacarpophalangeal joints and their accessory structures

作　　者：李征[1] 张振伟[1] 廖坚文[1] 秦贵林[1] 白印伟[1] 关助明[1] 余少校[1] 

机构地区：[1]广州医学院附属深圳沙井医院手外科,广东深圳518104

出　　处：《中国临床解剖学杂志》2009年第5期526-528,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的：观测第2~5掌指关节和附属结构的几何形态及其差异，为临床中解释压砸伤术后掌指关节屈曲障碍提供解剖学依据。方法：解剖10只成人手标本的第2~5掌指关节，测量各掌骨头、近节指骨基底最大前后径，伸直位掌骨头掌侧冠状面最高点与关节囊皱襞最低点的距离，观察关节囊及其附着点的形态。结果：掌骨头、近节指骨基底最大前后径比较无显著性差异，但第3掌骨头最大前后径（14．9±1．3mm）及中指近节指骨基底最大前后径（12．3±1．0）mm，关节囊掌侧附着点呈“W”字形。结论：（1）第3掌指关节前后径最大决定了临床压砸伤中受伤的几率最大、伤情最重，术后掌侧掌板和关节囊与骨关节面粘连造成屈曲障碍。（2）掌指关节屈曲障碍不能完全解释为侧副韧带挛缩，解决类似临床问题应以松解掌板和关节囊与骨关节面的粘连为主。Objective： To explore morphological difference of the 2st- 5th metacarpophalangeal joints and their accessory structures, and provide anatomic basis for the clinical explanation of post-operational metacarpophalangeal joint flexion dysfunction caused by crush injury. Methods：The 2nd- 5th metacarpophalangeal joints of 10 adult hands were dissected. The maximal anteroposterior diameters of all metacarpi and proximal phalanx fundi, the distance between the zenith of the unwinding point metacarpus volar frontal plane and the bottom of the joint capsule plica were measured, followed by observation of joint capsules and their attachment points. Results： There was no remarkable difference for maximal anteroposterior diameters between the metacarpi and proximal phalanx fundi, despite of the longest ones of the third metacarpus （ 14.9± 1.3mm ） and proximal phalanx fundus （12.3±1.0mm）. The volar attachment point of the joint capsule presented as a ＂W＂ shape. Conclusions： 1. The third metacarpophalangeal joint easy to be injuried during the clinical crush injury test, and caused post-operational flexion dysfunction due to the adhesion among the palm, the palm plate, the joint capsule and the facies articularis ossium, for its＇ long anteroposterior diameter. 2. We deem that, metacarpophalangeal joint flexion dysfunction cannot be defined completely as ligamenta collateralia contracture, and the solution to such clinical issue should mainly focus on the lysis of the adhesion among the palm plate, joint capsule and the facies articularis ossium.

关 键 词：掌指关节 解剖 压砸伤 粘连 

分 类 号：R323.7[医药卫生—人体解剖和组织胚胎学]