Sennwald G R, Zdravkovic V, Kern H P, Jacob H A
Chirurgie St. Leonhard, St. Gallen, Switzerland.
J Hand Surg Am. 1993 Sep;18(5):805-14. doi: 10.1016/0363-5023(93)90046-6.
Precise anatomic dissections of unembalmed physiologically intact cadaver specimens were carried out before proceeding with the kinematic investigations on further specimens. Carpal flexor and extensor tendons were used to move the wrist. The analysis of the carpal bone movements was performed according to the finite helical axis motion concept for increments of 10 degrees for each main carpal motion. Separate axes of rotation for each of the bones in the proximal carpal row were found; however, the axes for the lunate and triquetrum bones were close, and the magnitudes of rotation and translation almost equal. One finding was that the axes of rotation of the bones in the proximal carpal row often cross at some particular point. Because the axes of the scaphoid are differently oriented than those of the lunate and triquetrum, shear might occur during wrist motion. This indicates also that the scaphoid and lunate cannot be considered rigidly coupled elements. We also assume that the individual bones of the proximal carpal row self-align themselves as long as they are not constrained by torsion. Several potential mechanisms of flexion motion of the proximal carpal row during radioulnar deviations of the hand were considered. The ligament function is still an unsolved problem. Compensation mechanisms may mask clear correlations between a lesion and the instability pattern associated with it. The proximal carpal row should be studied as one system.
在对更多标本进行运动学研究之前，对未经防腐处理的生理完整尸体标本进行了精确的解剖。使用腕部屈肌腱和伸肌腱来移动手腕。根据有限螺旋轴运动概念，对每个主要腕骨运动以10度增量进行腕骨运动分析。确定了近侧腕骨排中每块骨头的单独旋转轴；然而，月骨和三角骨的轴很接近，旋转和平移的幅度几乎相等。一个发现是，近侧腕骨排中骨头的旋转轴经常在某个特定点交叉。由于舟骨的轴与月骨和三角骨的轴方向不同，手腕运动时可能会发生剪切。这也表明舟骨和月骨不能被视为刚性连接的元件。我们还假设，只要不受扭转约束，近侧腕骨排的各个骨头会自行对齐。考虑了手部桡尺偏斜时近侧腕骨排屈曲运动的几种潜在机制。韧带功能仍然是一个未解决的问题。补偿机制可能会掩盖病变与其相关不稳定模式之间的明显相关性。近侧腕骨排应作为一个系统进行研究。
