拇收肌的肌内肌腱及掌指关节的深层关节囊：一项对斯滕纳损伤可能有启示的解剖学研究
Intramuscular Tendon of the Adductor Pollicis and Underlying Capsule of the Metacarpophalangeal Joint: An Anatomical Study With Possible Implications for the Stener Lesion.
作者信息
Sato Tetsuya, Nimura Akimoto, Yamaguchi Reiko, Fujita Koji, Okawa Atsushi, Akita Keiichi
机构信息
Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
出版信息
J Hand Surg Am. 2018 Jul;43(7):682.e1-682.e8. doi: 10.1016/j.jhsa.2017.12.009. Epub 2018 Feb 1.
PURPOSE
To identify the layered relationship anatomically between the musculotendinous structures of the adductor pollicis, the ulnar collateral ligament, and the capsule of the metacarpophalangeal joint in terms of understanding the pathomechanism of a Stener lesion.
METHODS
We macroscopically analyzed 37 cadaveric thumbs to identify the intramuscular tendon of the adductor pollicis and bony attachments of the joint capsule including the ulnar collateral ligament. In addition, we histologically analyzed 3 thumbs and made a 3-dimensional image of 3 other thumbs, using micro-computed tomography.
RESULTS
The adductor pollicis has 3 components of an intramuscular tendon (dorsal, palmar, and distal), which connect to form a lambda shape. The dorsal part inserts into the joint capsule dorsal to the ulnar sesamoid. The palmar part inserts into the ulnar sesamoid. The distal part inserts into the lateral tubercle of the proximal phalanx. The thickened and cord-like part of the joint capsule, which has generally been referred to as the proper ulnar collateral ligament, has a distinct bony attachment on the proximal slope of the lateral tubercle of the proximal phalanx separate from the adductor pollicis insertion.
CONCLUSIONS
Of the 3 components of the intramuscular tendon of the adductor pollicis muscle, the dorsal part inserted into not only the aponeurosis but also the joint capsule.
CLINICAL RELEVANCE
The results of the current study suggest the anatomic basis for a possible pathomechanism of the Stener lesion.
目的
从理解斯滕纳（Stener）损伤的发病机制角度，解剖学上确定拇收肌的肌腱结构、尺侧副韧带和掌指关节囊之间的分层关系。
方法
我们对37具尸体拇指进行宏观分析，以确定拇收肌的肌内肌腱以及包括尺侧副韧带在内的关节囊的骨附着点。此外，我们对3个拇指进行了组织学分析，并使用微型计算机断层扫描对另外3个拇指制作了三维图像。
结果
拇收肌有3个肌内肌腱成分（背侧、掌侧和远侧），它们连接形成一个λ形。背侧部分插入尺侧籽骨背侧的关节囊。掌侧部分插入尺侧籽骨。远侧部分插入近节指骨的外侧结节。关节囊增厚且呈索状的部分，通常被称为尺侧副韧带，在近节指骨外侧结节的近端斜坡上有一个与拇收肌附着点分开的明显骨附着点。
结论
在拇收肌的肌内肌腱的3个成分中，背侧部分不仅插入腱膜，还插入关节囊。
临床意义
本研究结果提示了斯滕纳损伤可能发病机制的解剖学基础。
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