手指皮系韧带结构体系解剖研究  

Anatomical study on the structural system of cutaneous ligaments in fingers

作　　者：王强 王春霖 董丽琨 王增涛 Wang Qiang;Wang Chunlin;Dong Likun;Wang Zengtao(Department of Hand,Foot and Microreconstructive Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Medical Integration and Practice Center,Shandong University,Jinan 250014,China)

机构地区：[1]山东第一医科大学附属省立医院手足与显微重建外科,济南250021 [2]山东大学医学融合与实践中心,济南250014

出　　处：《中华解剖与临床杂志》2024年第5期316-321,共6页Chinese Journal of Anatomy and Clinics

摘　　要：目的研究手指皮系韧带的三维解剖结构及功能,为临床手术中皮系韧带损伤的预防和修复提供解剖学基础。方法选取山东第一医科大学附属省立医院修复重建研究所提供的红色乳胶灌注动脉的成人新鲜手标本9侧17指。解剖范围:从掌指关节至指尖。采用层次解剖、掌侧纵切提拉解剖及横断面解剖3种方法进行操作。观察皮系韧带的起源、走行、止点,以及与血管神经的位置关系。结果(1)Cleland韧带起自指骨侧方的两端:一部分纤维呈放射状分布到皮肤,另一部分纤维在指侧方形成板状韧带——指骨侧方韧带,再发出纤维至皮肤。指骨侧方韧带位于指固有动脉和神经的背外侧。手指掌侧斜向远端的纤维粗大、密集,侧方到皮肤的纤维最短,背侧纤维稀疏。(2)Grayson韧带起自指骨外侧嵴,在屈肌腱鞘与指固有动脉、神经之间浅出,发出放射状纤维,呈扇形分散至掌侧皮肤。两侧发出斜向近端的纤维在皮下相互交织成网状立体结构,限制皮肤的过度滑动。近侧指间关节与远侧指间关节纤维分布密集,与A3、A5滑车紧密相连,以适应手指掌侧屈曲活动。结论手指掌侧皮系韧带锚定皮肤更牢固,使手指能更稳固地抓握、提拉物体和捏持细小物品。背侧皮系韧带允许皮肤有较大滑动,以适应手指的屈伸活动。掌握手指皮系韧带的立体解剖结构,可减少其医源性损伤,并有助于更好地修复手指软组织。Objective This study aimed to investigate the three-dimensional anatomical structure and functions of cutaneous ligaments in fingers,thereby providing an anatomical basis for reducing cutaneous ligaments damage and for repairing damaged cutaneous ligaments during clinical operations.Methods A total of 17 fingers from nine specimens of adult fresh hands featuring red latex-infused arteries provided by the Institute of Repair and Reconstruction at the Provincial Hospital Affiliated with Shandong First Medical University,were selected.The dissection ranged from the metacarpophalangeal joint to the fingertips.Three methods,namely,layered dissection,palmar longitudinal incision and elevation,and cross-sectional dissection were utilized.Observations of the origins,trajectories,and insertion points of the cutaneous ligaments and their spatial relationships with the blood vessels and nerves were made.Results(1)The Cleland ligament originates from both ends of the bone side;some fibers radiate towards the skin,while other fibers form a plate-like ligament(the lateral collateral ligament of the phalanx)before fibers are sent to the skin.The lateral collateral ligament is positioned dorsolaterally to the digital arteries and nerves.On the palmar side,the fibers that slant distally are thick and dense,with the shortest fibers extending laterally to the skin and sparser fibers on the dorsum.(2)The Grayson ligament arises from the lateral tubercles of the phalanges,emerging superficially between the flexor tendon sheath and the digital arteries and nerves.Radiating fibers disperse in a fan-like pattern into the palmar skin.Fibers that obliquely extend proximally from both sides interlace beneath the skin,forming a mesh-like three-dimensional structure that restricts excessive skin sliding.The fibers are densely distributed near the proximal interphalangeal and distal interphalangeal joints and are intimately associated with the A3 and A5 pulleys to accommodate the flexion movements of the fingers.Conclusion The palmar cutaneou

关 键 词：皮系韧带 指损伤 显微解剖 功能 修复 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R658[医药卫生—基础医学]