腕管内蚓状肌的运动映射与定位——一项尸体研究
Motion mapping and positioning of lumbrical muscles in the carpal tunnel-a cadaveric study.
作者信息
Kothari Yogesh A, Kanna Raj, Kumar Bhaskarananda, Parida Amrita, Bhat Anil K
机构信息
Department of Hand Surgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Department of Orthopedics, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
出版信息
J Orthop. 2024 Dec 13;65:91-95. doi: 10.1016/j.jor.2024.12.009. eCollection 2025 Jul.
AIMS AND OBJECTIVES
Dynamic incursion of lumbrical muscle proximal to the distal edge of transverse carpal ligament (TCL) has been long debated for its role in causing median nerve compression in the carpal tunnel. This study aims to evaluate the pattern of lumbrical incursion into the carpal tunnel in various finger positions and determine their extent of presence and relationship with respect to the TCL and to each other in the carpal tunnel.
MATERIALS & METHODS: Dissection of 30 fresh frozen cadaveric hands was done to map the lumbrical muscles. The distance from each lumbrical muscle's proximal origin to the TCL's distal edge was measured using a Vernier caliper in three finger positions namely full extension, lumbrical, and full flexion position. Statistical tests like paired -test, ANOVA and Chi-Square test were used to evaluate the mean changes in lumbrical incursion, percentage of incursion, relative positions and the proportion of hands showing lumbrical origins proximal to the TCL.
RESULTS
The second lumbrical exhibited the highest mean incursion in all finger positions, followed by the third. Significant increases in incursion were observed from full extension to lumbrical position and from lumbrical position to full flexion in all lumbricals. The number of hands with lumbrical origins proximal to the TCL increased significantly from complete extension to complete flexion.
CONCLUSIONS
Lumbrical incursion significantly increases the content within the carpal tunnel with various finger positions. In full flexion, there is significant pressure of lumbricals within the tunnel. Hence, along with the tendons and median nerve, the lumbricals should be considered a dynamic content of the carpal tunnel. These muscles could significantly contribute to idiopathic Carpal tunnel syndrome in the backdrop of alteration in tunnel size or content. The second lumbrical, due to its proximal-most origin, is pivotal in this process.
LEVEL OF EVIDENCE
Level V.
目的与目标
腕横韧带（TCL）远侧边缘近端的蚓状肌动态侵入在导致腕管内正中神经受压中的作用长期以来一直存在争议。本研究旨在评估不同手指位置时蚓状肌侵入腕管的模式，并确定它们在腕管内相对于TCL的存在范围及其相互关系。
材料与方法
对30只新鲜冷冻尸体手进行解剖以绘制蚓状肌。使用游标卡尺在三个手指位置（即完全伸展、蚓状肌位和完全屈曲位）测量每条蚓状肌近端起点到TCL远侧边缘的距离。使用配对t检验、方差分析和卡方检验等统计测试来评估蚓状肌侵入的平均变化、侵入百分比、相对位置以及显示蚓状肌起点在TCL近端的手的比例。
结果
在所有手指位置，第二蚓状肌的平均侵入程度最高，其次是第三蚓状肌。在所有蚓状肌中，从完全伸展位到蚓状肌位以及从蚓状肌位到完全屈曲位，侵入程度均有显著增加。蚓状肌起点在TCL近端的手的数量从完全伸展位到完全屈曲位显著增加。
结论
在不同手指位置时，蚓状肌侵入显著增加了腕管内的内容物。在完全屈曲时，腕管内蚓状肌有显著压力。因此，与肌腱和正中神经一起，蚓状肌应被视为腕管的动态内容物。在腕管大小或内容物改变的背景下，这些肌肉可能对特发性腕管综合征有显著影响。由于其最近端的起点，第二蚓状肌在这一过程中起关键作用。
证据级别
V级。
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