关节韧带解剖学及生物力学特性研究进展(2)
作者:佚名; 更新时间:2014-12-13
力最大,而月三角韧带和舟大小多角头状骨韧带的张力最小。


  Savelberg[22](1991)对腕关节运动时部分掌侧和背侧韧带的长度变化做过研究。掌侧桡舟头韧带和背侧桡三角韧带,屈腕时的最大长度变化较尺 桡偏时大。最大桡偏时较中立位没有韧带明显伸长。最大尺偏时,桡舟头韧带、桡月韧带、三角头韧带的近侧部分和背侧腕关节韧带较中立位时明显伸长。最大背伸时,桡舟头韧带、桡月韧带的远侧部分和三角头韧带的近侧部分伸长明显,背侧腕关节韧带明显缩短。最大屈腕时,只有背侧腕关节韧带轻度伸长,其余韧带无明显伸长,桡舟头韧带、桡月韧带和三角头韧带明显缩短。掌侧月三角韧带,无论手腕做任何运动,其长度都没有明显变化。同时还注意到宽韧带的近、远两侧的长度变化是不同的。如尺偏时,桡月韧带的远侧伸长,而近侧部分无变化;三角头韧带的远侧部分 缩短,而近侧部分无变化。背伸时,三角头韧带的近侧部分伸长,而远侧部分无变化。


  Crison[23](1997)在活体上研究了锻炼活动对腕关节韧带刚度的影响,发现手腕的锻炼活动可以明显降低腕关节韧带的刚度,腕骨的位移活动度增加。休息1h后,腕关节韧带的刚度部分恢复到活动前的水平。24h后与活动前一样。说明了锻炼活动腕关节,可以降低腕关节韧带的刚度,增加了腕关节的松弛度,可以减少运动引起的损伤。


  腕关节韧带损伤后引起的腕关节不稳定,如舟月骨间分离,月三角骨不稳定等,治疗的方法很多,但效果有时不能肯定。最近Shin[24](1988)比较了舟月骨间韧带背侧部分与Lister结节处的第3伸肌支持韧带的生物力学特性和组织学特性,虽然第3伸肌支持韧带的断裂强度较舟月骨间韧带的背侧部分小许多,但单位面积上的断裂强度两者相差不大,两者的组织学特性相近。Weiss[25](1988)在临床上用两端带桡骨的第3伸肌支持韧带移植治疗舟月骨间分离19例病人,其中14例动力型舟月骨间分离,12例疼痛消失,2例腕关节重体力活动时疼痛;而 5例静力型舟月骨间分离,2例疼痛消失,1例腕关节重体力活动时疼痛,2例仍持续疼痛。作者认为用两端带桡骨的第3伸肌支持韧带移植治疗动力型舟月骨间分离的效果是可以的,而治疗静力型舟月骨间分离的效果差,其原因是第3伸肌支持韧带的强度不够。能否找到两端带骨,切取方便,韧带强度与腕部断裂韧带相近的更好供区,需要进一步研究。




  参考文献


  1,Mayfield JK.Patterns of injury to carpal ligaments.A spectrum.Clin Orthop,1984,187:36


  2,于胜吉,徐恩多.腕关节韧带的解剖学观察及其临床意义.解剖学杂志,1994,17(4):306


  3,North ER,Thomas S.An anatomic guide for arthroscopic visualization of the wrist capsular ligaments.J Hand Surg,1988,(5):815


  4,Mayfield JK.Mechanism of carpal injuries.Clin Orthop,1980,149:45


  5,Berger RA,Blair WF.The radioscapholunate ligament:A gross and histologic description.Anat Rec,1984,210:393


  6,王澍寰,主编.手部创伤的修复.北京:北京出版社,1997.362~370


  7,信捷职称论文写作发表网,Mayfield JK,Johnson PR,Kilcoyne RK.Carpal dislocations:Pathomechanics and progressive perilunar instability.J Hand Surg,1980,5:226


  8,Williams WJ,Mayfield JK,Erdman AG,et al.Biomechanical properties of human carpal ligaments.Orthop Trans,1979,4:26


  9,Berger RA,Kauer JMG,Landsmeer JMF.Radioscaphlunate ligament:A gross anatomic and histologic study of fetal and adult wrist.J Hand Surg,1991,16A:350


  10,Hixson ML,Stewart C.Microvascular anatomy of the radioscapholunate ligament of the wrist.J Hand Surg,1990,15A:279


  11,Taleisnik J.The ligaments of the wrist.J Hand Surg.1976,1:110


  12,包聚良,屠开元,徐印坎,等.腕关节囊内韧带的解剖学观察及其创伤学意义.中国临床解剖学杂志,1990,8(4):198


  13,Drewniany JJ,Palmer AK,Flatt AE,et al.The scaphotrapezial ligament complex:An anatomic and biomechanical study.J Hand Surg,1985,10A:492


  14,Berger RA.The gross and histologic anatomy of scapholunate interosseous ligament.J Hand Surg,1996,21A:170


  15,Svoboda SJ,Eglseder WA,Belkoff SM,et al.Autografts from the foot for reconstruction of scapholunate interosseous ligament.J Hand Surg,1995,20A:980


  16,Short WH,Werner FW,Fortino MD,et al.A dynamic biomechanical study of scapholunate ligament sectioning.J Hand Surg,1995,20A:986


  17,Boabighi A,Kuhlmann JN,Kenesi C.The distal ligamentous complex of the scaphoid and the scapho-lunate ligament.An anatomic histological and biomechanical stud y.J Hand Surg,1993,18B:65


  18,Ritt MJPF,Berger RA,Kauer JMG.The gross and histologic anatomy of the ligaments of the capitohamate joint.J Hand Surg,1996,21A;1022


  19,Dzwierzynski WW,Matloub HS,Yan JG,et al.Anatomy of the intermetacarpal ligament of the carpometacarpal joint of the fingers.J Hand Surg,1997,22A:931


  20,Kleinman WB,Graham JJ.The distal radioulnar joint capsule:Clinical anatomy and role in posttraumatic limitation of forearm rotation.J Hand Surg,1998,23A:588


  21,Weaver L,Tencer AF,Trumble TE,et al.Tensions in the palmar ligaments of the wrist.I.the normal wrist.J Hand Surg,1994,19A:464


  22,Savelberg HHCM,Kooloos JGM,Lange AD,et al.Human carpal ligament recruitment and three-dimensional carpal motion.J Orthop Res,1991,9:693


  23,Crisco JJ,Chelikani S,Brown RK,et al.The effects of exercise on ligamentous stiffness in the wrist.J Hand Surg,1997,22A:44


  24,Shin SS,Moore DC,McGovern RD,et al.Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft:A biomechanic and histologic study.J Hand Surg,1998,23A:216


  25,Weiss A-PC.Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft.J Hand Surg,1998,23A:205    

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