Gnanasekaran Dhivyalakshmi, Veeramani Raveendranath, Karuppusamy Aravindhan
Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Pondicherry, 605006, India.
Surg Radiol Anat. 2018 Sep;40(9):1007-1012. doi: 10.1007/s00276-018-2029-x. Epub 2018 Apr 18.
Knowledge of anatomical landmark to pulley system of the thumb is essential in successful treatment of trigger thumb release either by percutaneous or by minimally invasive technique. Though surgical release of trigger thumb is done commonly, there is paucity of data in the literature regarding its surface landmarks. The purpose of this study is to identify palmar surface anatomical landmarks to the pulley system of the thumb.
Dissection was performed on 55 fresh frozen adult cadaveric thumbs. The palmar thumb creases were given names as the proximal-proximal crease (PPC) present at the metacarpophalangeal joint, the distal-proximal crease (DPC) over the middle of the proximal phalanx and the distal crease (DC) at interphalangeal joint. The distance between the proximal edges of each pulley to the three thumb creases and longitudinal length of A1, A2, oblique and Av pulley was measured using digital vernier caliper and was expressed in mean and standard deviation.
The proximal edge of A1 pulley was 1.98 ± 1.61 mm proximal to the PPC. The mean longitudinal length of the A1 pulley was measured to be 5.06 ± 0.87 mm, so the distal edge of the A1 pulley was calculated to lie 3.08 mm distal to PPC. The proximal edge of Av and oblique pulley was situated 7.78 ± 2.5 and 15.72 ± 3.22 mm distal to PPC, respectively. The proximal edge of A2 pulley was very nearer and 2.88 ± 1.79 mm proximal to DC.
The knowledge of anatomical skin surface landmarks is helpful in the percutaneous release or minimally invasive procedure. The PPC serves as a definite landmark for A1, Av and oblique pulley whereas it is the DC for A2 pulley.
了解拇指滑车系统的解剖标志对于经皮或微创技术成功治疗扳机指至关重要。尽管扳机指的手术松解很常见，但文献中关于其体表标志的数据却很少。本研究的目的是确定拇指滑车系统的掌面解剖标志。
对55个新鲜冷冻的成人尸体拇指进行解剖。将拇指掌侧皮纹命名为位于掌指关节处的近端近端皮纹（PPC）、近端指骨中部上方的远端近端皮纹（DPC）和指间关节处的远端皮纹（DC）。使用数字游标卡尺测量每个滑车近端边缘到三条拇指皮纹的距离以及A1、A2、斜滑车和Aｖ滑车的纵向长度，并以平均值和标准差表示。
A1滑车近端边缘位于PPC近端1.98±1.61mm处。A1滑车的平均纵向长度为5.06±0.87mm，因此A1滑车远端边缘计算位于PPC远端3.08mm处。Aｖ滑车和斜滑车近端边缘分别位于PPC远端7.78±2.5和15.72±3.22mm处。A2滑车近端边缘非常靠近DC且位于DC近端2.88±1.79mm处。
了解解剖学皮肤表面标志有助于经皮松解或微创手术。PPC是A1、Aｖ和斜滑车的明确标志，而DC是A2滑车的标志。
