摘要
目的观察腕关节三角纤维软骨复合体（triangular fibrocartflage complex，TFCC）的神经来源、内部神经分布，为腕尺侧痛提供病因基础，进而为其临床治疗提供懈剖学依据。方法对30例成年男性腕关节标本进行解剖，首先观察腕尺侧组织及TFCC的神经支配，之后观察三角纤维软骨（triangular fibrocartilage，TFC）周围韧带的组成及起止。最后选取10例标本，利用大鼠抗人单克隆PGP9．5抗体和Cy3标记的山羊抗大鼠IgG，通过免疫荧光染色技术，对TFCC内部神经分布行定量观察。结果TFCC的韧带组成除包括国内外报告的尺月韧带、尺三角韧带（均抵止于对应腕骨掌侧）、桡尺远侧韧带、尺侧副韧带、尺侧腕伸肌腱鞘之外，还包括尺月、尺三角背侧韧带。腕尺侧及TFCC的神经支配主要来自于尺神经手背支的腕关节支和前臂内侧皮神经，而且主要分布于尺侧，尤其是固有部（internal portion，IP）。结论TFCC的尺月、尺三角韧带不仅止于对应腕骨的掌侧，同时也发出纤维抵止于对应腕骨的背侧。腕尺侧及TFCC的神经支配主要来自于尺神经手背支的腕关节支和前臂内侧皮神经，不受单一神经支配，其内部神经主要分布在尺侧，尤其是IP，顽固性尺侧腕痛可以行去神经支配术。
Objective To investigate the triangular fibrecartilage complex （TFCC） structure, ligaments around it and its innervation, and provide anatomical basis to the treatment of ulnar-sided wrist pain from TFCC injuries with selective denervation procedure. Methods Thirty adult cadaveric wrists were dissected. Innervation of the soft tissues on ulnar side of the wrist and of the TFCC was observed under 10 x magnification. Structure, origin and attachment of the ligaments around triangular fibrooartilnge （TFC） were also studied. Another 10 specimens were used to quantitatively study the innervation of TFCC via immunofluorescenee technique using rat monoelonal anti-human PGP9.5 antibody and Cy3-eonjngated goat anti-rat IgG. Results Ligaments around TFC included the ulnolunate ligament and ulnotriquetrum ligament, which beth attach to the volar side of the corresponding carpal bones, the collateral ulnar ligament, distal radioulnar ligament, radioulnar triquetral ligament and sheath of the extensor carpi ulnaris. Besides the above ligaments that concur with the literature, we found that the dorsal ulnolunate ligament and dorsal ulnotriquetrum ligament also contributed to TFCC. Innervation of ulnar carpal soft tissues and TFCC was from dorsal branches of the ulnar nerve and the medial antebrachial cutaneous nerve. The most densely innervated part was the ulnar side and internal portion of TFCC. Candusion The ulnolunate and ulnotriquetrum ligaments attach beth the volar and dorsal side of corresponding carpal bones. Innervation of ulnar carpal soft tissues and TFCC is from dorsal branches of the ulnar nerve and the medial antebrachial cutaneous nerve, instead of single nerve innervation. The nerve fibers are predominantly located on the ulnar side of the TFCC, especially in the internal portion. Refractory ulnar-sided wrist pain can be treated with the denervation procedure.
出处
《中华手外科杂志》
CSCD
北大核心
2012年第4期202-205,共4页
Chinese Journal of Hand Surgery
基金
吉林省卫生厅课题基金资助项目（2009ZC044）
