Marí-Gorreto Jesús, San-Millán Marta, Carrera Ana, Tubbs R Shane, Iwanaga Joe, Cateura Aïda, Acquabona Laura, Reina Miguel A, Reina Francisco
Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain.
Medical Sciences Department, Clinical Anatomy, Embryology and Neuroscience Research Group (NEOMA), Faculty of Medicine, University of Girona, Girona, Spain; EUSES University School of Health and Sports, University of Girona, Salt, Girona, Spain.
Ann Anat. 2023 Apr;247:152068. doi: 10.1016/j.aanat.2023.152068. Epub 2023 Feb 6.
The anatomical literature describes the abductor pollicis longus as a muscle with a single tendon inserting on the base of the first metacarpal bone, but investigations have shown that it often exhibits morphological variations. However, methodological approaches used to describe these variations have not been useful in a clinical context. Therefore, the purpose of this investigation was to study and relate such anatomical variations in a clinical context.
Thirty upper limbs from the body donation program were dissected using standard procedures to identify the number of abductor pollicis longus (APL) tendons, their position, site of insertion, length, width and thickness. The presence or absence of the extensor pollicis brevis muscle was also noted. Inter and intra-observer reliability was analysed.
A total number of 71 tendons from the APL muscle were found in the thirty limbs. The most frequent distribution pattern was a main tendon inserted on the base of the first metacarpal and an accessory tendon inserted into the abductor pollicis brevis muscle. These tendons could divide into various tendinous slips that could insert in different locations. Also, clustering algorithms and classical statistical tests showed tendons inserting on the first metacarpal were longer than tendons not inserting on the first metacarpal (p = 0.03), while medial tendons and tendons from an APL muscle with supernumerary tendons were narrower (p < 0.001). The absence of the extensor pollicis brevis muscle was not related to the presence of supernumerary APL tendons.
Radiological and surgical implications of these results are important when examining this region of the hand and wrist. The pathophysiology and treatment of de Quervain's tenosynovitis, trapeziometacarpal arthritis and trapeziometacarpal subluxation or laxity could be influenced by the results of our findings.
解剖学文献将拇长展肌描述为一条肌腱单一的肌肉，其肌腱插入第一掌骨基部，但研究表明该肌肉常呈现形态变异。然而，用于描述这些变异的方法在临床环境中并无实际用途。因此，本研究的目的是在临床背景下研究并关联此类解剖变异。
使用标准程序解剖来自遗体捐赠项目的30例上肢标本，以确定拇长展肌（APL）肌腱的数量、位置、插入部位、长度、宽度和厚度。同时记录拇短伸肌的有无情况。分析了观察者间和观察者内的可靠性。
在这30例上肢中，共发现71条来自APL肌肉的肌腱。最常见的分布模式是一条主肌腱插入第一掌骨基部，一条副肌腱插入拇短展肌。这些肌腱可分为不同的腱束，插入不同位置。此外，聚类算法和经典统计检验表明，插入第一掌骨的肌腱比未插入第一掌骨的肌腱更长（p = 0.03），而内侧肌腱和来自有额外肌腱的APL肌肉的肌腱更窄（p < 0.001）。拇短伸肌的缺失与额外的APL肌腱的存在无关。
在检查手部和腕部该区域时，这些结果的放射学和手术意义重大。我们的研究结果可能会影响桡骨茎突狭窄性腱鞘炎、第一腕掌关节关节炎以及第一腕掌关节半脱位或松弛的病理生理学和治疗方法。
