Gausepohl T, Koebke J, Pennig D, Thiel J
Abteilung für Unfallchirurgie, Hand- und Wiederherstellungschirurgie des St. Vinzenz-Hospitals, Köln.
Handchir Mikrochir Plast Chir. 1998 Jul;30(4):220-5.
Finger flexion initiated at the distal and proximal interphalangeal joint level forces the extensor tendon to move distally. Therefore, the interosseous hood fixed to the extensor apparatus moves distally, too. The proximal part of the hood which is located at the level of the metacarpal head during extension of the finger slides distally along the basis of the proximal phalanx. Due to the much smaller cross-section of the phalanx compared to the metacarpal head, the palmar border of the interosseous hood is shifted palmarly. This produces a two-fold effect concerning the metacarpophalangeal joint. First, it leads to an increasing flexion moment of the intrinsic muscles during flexion of the metacarpophalangeal joint. Second, the same mechanism improves the ability of abduction and adduction in the metacarpophalangeal joint during extension of the finger. In this position, the proximal part of the interosseous hood covers the metacarpal head and the strong palmar bundles of the hood are pushed to the ulnar and radial sides resulting in a greater distance to the abduction/adduction axis of the MP-joint. The other effect concerns the proximal interphalangeal joint. The described transformation of the interosseous hood during flexion especially of its proximal part causes a curved deformation of the strong palmar border of the interosseous hood. The power of the intrinsic muscles inserting at the interosseous hood is passed along this smooth curve on its way to the dorsal side of the proximal interphalangeal joint thus allowing a continuous extension of the proximal interphalangeal joint in all flexion phases of the MP-joint. The typical transformation of the interosseous hood is regulated by the form of the underlying bone and ligament apparatus and can be understood as a passive mechanism effecting in a senseful change of muscle function as the active element during finger flexion and extension. These not yet described morphological data concerning the transformation of the interosseous hood during finger flexion and the functional interpretation complete the former described mechanism of flexion by Landsmeer (1955) and Landsmeer and Long (1965).
手指在远侧和近侧指间关节水平开始屈曲时,会迫使伸肌腱向远侧移动。因此,固定于伸肌装置的骨间肌筋膜也向远侧移动。在手指伸展时位于掌骨头水平的骨间肌筋膜近端部分,沿着近节指骨基部向远侧滑动。由于指骨的横截面比掌骨头小得多,骨间肌筋膜的掌侧缘向掌侧移位。这对掌指关节产生了双重作用。首先,在掌指关节屈曲时,它会导致内在肌的屈曲力矩增加。其次,相同的机制在手指伸展时提高了掌指关节的外展和内收能力。在这个位置,骨间肌筋膜的近端部分覆盖掌骨头,并且骨间肌筋膜强大的掌侧束被推向尺侧和桡侧,导致与掌指关节外展/内收轴的距离更大。另一个作用涉及近侧指间关节。在屈曲过程中,尤其是其近端部分,骨间肌筋膜的上述转变会导致骨间肌筋膜强大的掌侧缘出现弯曲变形。附着于骨间肌筋膜的内在肌的力量在其到达近侧指间关节背侧的途中沿着这条平滑曲线传递,从而在掌指关节的所有屈曲阶段允许近侧指间关节持续伸展。骨间肌筋膜的典型转变受其下方骨骼和韧带结构的形式调节,并且可以被理解为一种被动机制,在手指屈伸过程中作为主动元件实现肌肉功能的有意义变化。这些尚未描述的关于手指屈曲时骨间肌筋膜转变的形态学数据以及功能解释完善了Landsmeer(1955年)和Landsmeer与Long(1965年)之前描述的屈曲机制。