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目的研究拇指腕掌关节韧带的解剖学特点及各韧带在拇指运动中的作用,为韧带重建提供形态学基础。方法放大镜下解剖成人男性尸体20例新鲜手标本,观察拇指腕掌关节韧带的起止点及附着部位,分别测量各韧带在中立位下的长、宽、厚及最大拉伸长度,测量关节的活动范围。结果拇指腕掌关节周围共5条韧带,其中桡背韧带、后斜韧带、前斜韧带为囊内韧带,第1骨间韧带、尺侧韧带为囊外韧带。在囊内韧带中,最厚的是桡背韧带(2.08±0.27)mm,最薄的是前斜韧带(1.14±0.17)mm。最宽的是前斜韧带(9.33±1.09)mm,最窄的是后斜韧带(7.23±0.88)mm。延伸率最大的是桡背韧带(57.33±9.21%),最小的是前斜韧带(38.43±8.26%)。结论拇指腕掌关节存在三级稳定结构,在关节囊韧带中,桡背韧带厚韧而紧张,对维持关节稳定性起重要作用,前斜韧带薄而松弛,外伤或自发性劳损引起退行性变可能性较大,拇指腕掌关节炎应该首选重建前斜韧带。
Objective To study the anatomical features of the ligaments of the thumb and the effects of the ligaments on the movement of the thumb to provide the morphological basis for ligament reconstruction. Methods Fresh hands were dissected from 20 adult male cadavers under the magnifying glass. The starting and ending points and attachment sites of the ligaments of the wrist were observed. The length, width and thickness of the ligaments at the neutral position were measured respectively. The joint activities range. Results There were 5 ligaments around the wrist of the thumb. Among them, the radial dorsal ligament, posterior oblique ligament and anterior oblique ligament were intracapsular ligaments. The first interosseous ligament and the ulnar ligament were extracapsular ligaments. In the intracapillary ligament, the thickest is the dorsal radial ligament (2.08 ± 0.27) mm, the thinnest is the anterior oblique ligament (1.14 ± 0.17) mm. The widest anterior oblique ligament (9.33 ± 1.09) mm, the narrowest posterior oblique ligament (7.23 ± 0.88) mm. The largest rate of extension of the dorsal radial ligament (57.33 ± 9.21%), the smallest is the anterior oblique ligament (38.43 ± 8.26%). CONCLUSIONS: There are three levels of stable structures in the thumb and wrist joints. In the capsular ligament, the dorsal and radial ligaments are thick and tense. They play an important role in maintaining the stability of the joints. The anterior oblique ligaments are thin and loose, causing degenerative changes due to trauma or spontaneous strain Possibly, the thumb wrist arthritis should be preferred reconstruction of the anterior oblique ligament.