Cobb T K, Dalley B K, Posteraro R H, Lewis R C
Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, Lubbock.
J Hand Surg Am. 1993 Jan;18(1):91-9. doi: 10.1016/0363-5023(93)90251-W.
For an accurate definition of the anatomic limits of the carpal tunnel, 26 cadaver upper extremities were studied by gross (10), histologic (3), and radiographic (13) methods. The mean proximal limit of the central portion of the flexor retinaculum was 11 mm distal to the capitate-lunate joint, and the mean distal limit of the distal portion was 10 mm distal to the carpometacarpal joint of the third metacarpal. Carpal tunnel width at the hook of the hamate (20 mm) was significantly smaller than its proximal (24 mm) or distal (25 mm) extent. The flexor retinaculum extended from the distal aspect of the radius to the distal aspect of the base of the third metacarpal. We redefined the palmar boundary of the carpal tunnel to include three continuous segments of flexor retinaculum: the thin proximal segment composed of thickened deep investing fascia of the forearm; the transverse carpal ligament; and the distal portion of the flexor retinaculum, composed of an aponeurosis between the thenar and hypothenar muscles. In light of recent operative procedures that divide only the transverse carpal ligament, this study provides an anatomic basis for a more extensive release.
为精确界定腕管的解剖学界限，我们采用大体观察（10例）、组织学观察（3例）和影像学观察（13例）的方法，对26具尸体的上肢进行了研究。屈肌支持带中央部分的平均近端界限位于头状骨-月骨关节远侧11毫米处，远侧部分的平均远端界限位于第三掌骨掌指关节远侧10毫米处。钩骨钩处的腕管宽度（20毫米）明显小于其近端（24毫米）或远端（25毫米）的宽度。屈肌支持带从桡骨远端延伸至第三掌骨基部远端。我们重新界定了腕管的掌侧边界，使其包括屈肌支持带的三个连续部分：由前臂增厚的深筋膜组成的薄的近端部分；腕横韧带；以及由大鱼际肌和小鱼际肌之间的腱膜组成的屈肌支持带远端部分。鉴于近期仅切开腕横韧带的手术操作，本研究为更广泛的减压提供了解剖学依据。
