Minamikawa Y, Horii E, Amadio P C, Cooney W P, Linscheid R L, An K N
Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minn. 55905.
J Hand Surg Am. 1993 Mar;18(2):198-204. doi: 10.1016/0363-5023(93)90345-4.
The kinematics of the intact proximal interphalangeal joint of 12 fresh cadaver index fingers were measured by means of an electromagnetic tracking system. The specimens were then randomly divided into two groups for ligament sectioning in two different sequences and for testing under lateral stress. Lateral stress of the intact proximal interphalangeal joints produced an average of 5 degrees of adduction and 9 degrees of supination motion throughout the arc of flexion/extension. Maximum lateral angulation was 15 degrees under 1 kg of force (30 N cm) applied at the distal end of the middle phalanx. Joint angulation increased to 20 degrees after total sectioning of the collateral ligament. Joint laxity was greatly reduced in full extension, in full flexion, and when the muscles were loaded. The proximal interphalangeal joint remained stable when one half of the collateral ligament was left intact. The results indicate that lateral stability of the proximal interphalangeal joint is provided primarily by the collateral ligament. When the lateral stress test is normal in proximal interphalangeal joint extension, an additional test in 20 to 30 degrees of flexion should be considered to avoid a false-negative result. Angulation greater than 20 degrees is abnormal and indicates a loss of collateral ligament integrity.
采用电磁跟踪系统对12个新鲜尸体示指完整的近端指间关节的运动学进行了测量。然后将标本随机分为两组，按照两种不同顺序切断韧带，并在侧方应力下进行测试。完整的近端指间关节在整个屈伸弧中，侧方应力平均产生5度内收和9度旋后运动。在中节指骨远端施加1千克力（30牛·厘米）时，最大侧方成角为15度。侧副韧带完全切断后，关节成角增加到20度。在完全伸展、完全屈曲以及肌肉加载时，关节松弛度大大降低。当保留一半侧副韧带完整时，近端指间关节保持稳定。结果表明，近端指间关节的侧方稳定性主要由侧副韧带提供。当近端指间关节伸展时侧方应力试验正常时，应考虑在20至30度屈曲位进行额外试验，以避免假阴性结果。成角大于20度为异常，表明侧副韧带完整性丧失。
