拇指腕掌关节周围韧带的解剖学分析

目的　解剖拇指腕掌关节周围各条韧带及观察其组织形态学特征，探讨其在拇指腕掌关节稳定性中的作用。 方法　采用大体解剖学方法对10例新鲜冰冻手标本进行解剖，识别拇指腕掌关节周围韧带的连接部位与方向性，对韧带的宽度、长度、厚度进行形态学对比分析。并组织学观察拇指腕掌关节背侧和掌侧韧带细胞数。 结果　确定拇指腕掌关节周围存在7条主要韧带：即由3条背侧韧带（桡背侧韧带、背侧中央韧带、后斜韧带）组成的复合体，厚度分别为(1.24±0.12)、(1.91±0.15)、(1.61±0.12) mm。2条掌侧韧带（前斜韧带、尺侧副韧带），厚度分别为(0.78±0.11) mm、 (1.03±0.11) mm。2条尺侧韧带（大多角骨-第1掌骨背侧韧带,第1、2掌骨间韧带），厚度分别为(0.78±0.19) mm、(0.89±0.19) mm。背侧韧带明显厚于掌侧韧带（P<0.01），桡背侧韧带、背侧中央韧带、后斜韧带的细胞数多于前斜韧带，后斜韧带的细胞数也多于尺侧副韧带，均有统计学差异（P<0.05）。 结论　3条背侧韧带组成粗厚坚韧的复合体，在拇指腕掌关节的稳定中，前斜韧带起着更大的作用。

Anatomical analysis of the thumb carpometacarpal joint ligaments

Objective　To dissect the ligaments surrounding the first carpometacarpal joint and observe its histologic characteristics, and to explore the role of the supporting ligaments in maintaining the stability of the first carpometacarpal joint.　Methods　Ligaments connection site and direction were identified in 10 frozen fresh cadavers and its width, length, and thickness were measured and recorded for morphometric analysis and comparison. The dorsal and volar ligaments were excised from the fresh- frozen specimens for further histological observation.　Results　Seven ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments complex (dorsal radial, dorsal central, posterior oblique), whose thickness were (1.24±0.12) mm , (1.91±0.15) mm, and (1.61±0.12) mm, resepectively. Two volar ligaments (anterior oblique and ulnar collateral), whose thickness were (0.78±0.11) mm, and (1.03±0.11) mm, respectively. Two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal), whose thickness were (0.78±0.19) mm, and (0.89±0.19) mm, respectively. The dorsal ligaments were significantly thicker (P<0.01) than the volar ligaments. The dorsal radial ligament, dorsal central ligament and posterior oblique ligament had a significantly greater cellularity compared with the anterior oblique ligament. Cells in posterior oblique ligament were also more than the ulnar collateral ligament; there were significant differences (P<0.05).Conclusions　Three dorsal ligaments are a thick and tough complex, which play a more important role in thumb carpometacarpal joint stability.