Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University, CA 94304, USA.
J Bone Joint Surg Am. 2012 Aug 15;94(16):1468-77. doi: 10.2106/JBJS.K.00329.
Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability.
Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments.
Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity.
The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and is more structurally consistent with a capsular structure than a proper ligament.
稳定性和活动性代表了人类拇指腕掌关节的矛盾需求，但每种功能需求的结构起源定义得很差。多达 16 条和少至 4 条韧带被描述为主要稳定器，但关于哪些韧带最重要存在争议。我们假设对拇指腕掌关节的韧带进行宏观和微观比较分析将进一步确定它们在关节稳定性中的作用。
从 19 具尸体（8 名女性，11 名男性；死亡时的平均年龄为 76 岁）中解剖了 30 只手（10 只新鲜冷冻和 20 只防腐），并确定了拇指腕掌关节的支持韧带。记录韧带的宽度、长度和厚度，进行形态计量学分析，并使用学生 t 检验进行比较。从新鲜冷冻标本中取出背侧和掌侧韧带，并用三重染色免疫荧光技术染色，并对感觉神经支配进行半定量分析；其中一半标本还进行了组织形态计量学数据的分析。混合效应线性回归用于估计韧带之间的差异。
确定了拇指腕掌关节的 7 条主要韧带：3 条背侧三角韧带（背侧桡侧、背侧中央、后斜）、2 条掌侧韧带（前斜和尺侧副韧带）和 2 条尺侧韧带（背侧梯形和掌骨间）。背侧韧带明显比掌侧韧带厚（p < 0.001），与前斜韧带相比，细胞数量更多，感觉神经支配更多（p < 0.001）。前斜韧带始终是一种薄结构，组织学上表现为具有低细胞密度的囊组织。
背三角韧带复合体均匀粗壮；该韧带复合体在形态上最粗壮，组织学上细胞数量最多，感觉神经末梢最多。细胞数量较少的前斜韧带很薄，位置多变，在结构上更类似于囊组织，而不是真正的韧带。
