Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre chirurgical Emile Gallé, CHU de Nancy, 49, rue Hermite, 54000 Nancy, France.
Department of Anatomy, Faculty of Medicine, University of Lorraine, 9, avenue de la Forêt de Haye, 54505 Vandœuvre-lès-Nanc, France.
Hand Surg Rehabil. 2021 Apr;40(2):134-138. doi: 10.1016/j.hansur.2020.10.015. Epub 2020 Dec 10.
Using a cadaver study, we described a new dorsal approach to the wrist joint using a "U-shaped with proximal base" capsulotomy. Six fresh adult cadaveric wrists were dissected after intra-arterial silicone injection. We did a dorsal approach to expose the dorsal joint capsule. It was then possible to identify the dorsal radiocarpal and intercarpal ligaments, the dorsal radiocarpal and intercarpal arterial arches, the dorsal branch of the anterior interosseous artery and the terminal branch of the posterior interosseous nerve. Wrist arthrotomy was done using our capsulotomy. In each dissected capsular flap, we always found the individual ligament, vascular, and nerve structures, implying they were intact over their trajectories. The mean surface area of the articular exposure was 945 mm (range 725-1102 mm) allowing easy access to the carpal bones and the radiocarpal and midcarpal joint spaces. This surgical approach to the wrist is technically feasible and avoids damaging the dorsal extrinsic ligaments fibers. Keeping the vascularization intact could improve capsular healing, while preserving innervation could maintain wrist proprioception.
我们通过尸体研究，描述了一种新的腕关节背侧入路，采用“U 形基底近端”的囊切开术。在动脉内硅酮注射后，对 6 个新鲜成人尸体腕关节进行解剖。我们采用背侧入路暴露背侧关节囊。然后可以识别背侧桡腕和腕骨间韧带、背侧桡腕和腕骨间动脉弓、骨间前动脉背侧分支和骨间后神经终末支。使用我们的囊切开术进行腕关节切开术。在每个解剖的囊瓣中，我们始终发现了单独的韧带、血管和神经结构，这意味着它们在其轨迹上是完整的。关节暴露的平均表面积为 945mm（范围 725-1102mm），可轻松进入腕骨和桡腕关节和腕中关节间隙。这种腕关节的手术入路在技术上是可行的，并且可以避免损伤背侧外在韧带纤维。保持血管完整性可以促进囊愈合，而保留神经支配可以维持腕关节本体感觉。
