锤状指治疗中固定指位的应用解剖研究  

The applied anatomy of the fixed finger position in the treatment of mallet finger

作　　者：孙文弢 张文龙[1] 张净宇[1] 董亮[1] 王建[1] 

机构地区：[1]唐山市第二医院(华北理工大学附属骨科医院)临床解剖实验室,手外二科,河北省063000

出　　处：《中华解剖与临床杂志》2017年第1期33-36,共4页Chinese Journal of Anatomy and Clinics

摘　　要：目的：探讨成人新鲜上肢标本指间关节活动对伸肌腱Ⅰ～Ⅱ区伸肌腱的影响,为临床锤状指治疗中固定指位的选择提供解剖学基础。方法纳入成人新鲜上肢标本16侧,取示、中、环、小指各16指,分别于各指在近侧指间关节0°伸直位、45°屈曲位和90°屈曲位时,测量远侧指间关节的最大被动屈曲角度。显露伸肌腱Ⅰ～Ⅱ区,制作锤状指畸形模型,克氏针在中节指骨颈水平垂直于指骨长轴穿透指骨作为参照,于伸肌腱Ⅱ区上做标记,测量肌腱滑动距离。固定远侧指间关节于0°伸直位,近侧指间关节自0°伸直位至90°屈曲位,观察伸肌腱Ⅱ区断端间隙距离的变化,并测量肌腱的滑动距离。结果实验显示,当近侧指间关节于90°屈曲位时,远侧指间关节的最大被动屈曲角度较近侧指间关节于0°伸直位时增加约21%；近侧指间关节处于0°伸直位时,示指、中指、环指及小指的伸肌腱Ⅱ区末端断端间隙距离分别为（0.35±0.06） mm、（0.42±0.05） mm、（0.46±0.06） mm、（0.51±0.08） mm；固定远侧指间关节,屈曲近侧指间关节至90°屈曲位时,近侧断端向远侧滑移,示指、中指、环指及小指的滑移距离分别为（0.69±0.09） mm、（0.74±0.03） mm、（0.80±0.07） mm、（0.81±0.10）mm,且最终远近两侧断端重叠。结论当远侧指间关节于轻度过伸位、近侧指间关节于屈曲位时,断端间隙消失,此时伸肌腱Ⅰ～Ⅱ区松弛,张力降低。在锤状指治疗应用上述指位可降低肌腱张力,利于肌腱愈合。Objective To discuss the effect of interphalangeal joint activity in this area of the extensor tendon and to provide the anatomical basis for the fixed position in the treatment of the Mallet finger through the anatomy study on zoneⅠ-Ⅱof extensor tendon in fresh adult specimen of the upper extremity. Methods The maximum passive flexion angle of 2nd -5th distal interphalangeal point （ DIPJ） from 16 fresh embalmed cadaver hands were measured with the proximal interphalangeal point （PIPJ） in 0°, 45° and 90° flexion position. The extensor tendon area was exposed in zone Ⅰ-Ⅱ, and then was cut to make a mallet finger model. A Kirsches wire was pierced through the phalanx axis vertically in the middle phalanx neck level as a reference. A mark was made in the extensor tendon for the use of measuring the tendon gliding distance. The broadest gaps between the tendon edges and the tendon gliding distances were measured when the PIPJ was flexed extension 0° to flexion 90° position. Results The maximum passive flexion angle of the DIPJ increased about 21% when the PIPJ was flexed from extension 0° to flexion 90° position. The gap between the extensor tendon edges in zoneⅡof forefinger, middle finger, ring finger and little finger were （0. 35 ± 0. 06）mm, （0. 42 ± 0. 05）mm, （0. 46 ± 0. 06）mm, and （0. 51 ± 0. 08）mm when the PIPJ was in extension 0° position. The proximal side of gap slipped to the distal side and the slipping distance of forefinger, middle finger, ring finger and little finger were（0. 69 ± 0. 09） mm, （0. 74 ± 0. 03） mm, （0.80 ±0.07）mm, and （0.81 ±0.10）mm when the PIPJ was flexed to 90°. Conclusions When the DIPJ is in mild over extension position and the DIPJ in flexion position, the gap between the tendons edges disappears. The extensor tendon in zoneⅠ-Ⅱis loose, and the tension decreases. In the treatment of mallet finger, the above mentioned finger positions can reduce the tension of the tendon, which is beneficial to the healing of the te

关 键 词：指关节 锤状指 伸肌腱 解剖学 

分 类 号：R687.3[医药卫生—骨科学] R322.7[医药卫生—外科学]