钩骨第5掌腕关节面的解剖学特征
王海明，范存义，姜佩珠，蔡培华，王金武，曾炳芳
临床相关性：钩骨掌腕关节面与部分手指近节指骨基底关节面相似，且关节面位于手掌尺侧，位置隐蔽，关节活动甚微，必要时可作为植骨的修补供区。
偏倚或不足：课题中钩骨第5掌腕关节面与手指近节指骨基底关节面的弧度测量有一定难度，希望将来能借助其他测量方法来加以完善，这样能更好的评估关节面的相似度。
相关链接：随着组织工程学的不断发展，同种异体骨关节移植，尤其是延长移植关节的成活时间，将成为热点课题。自体带血管关节移植术，是治疗手指关节缺损较好的方法，如何使操作简便、副损伤减小及寻找新的关节供区，值得进一步研究。
摘要
背景：依据钩骨第5掌腕关节面的形态及功能特点，可否能成为手骨缺损的关节移植供区？
目的：基于钩骨第5掌腕关节面关节移植供区的解剖学特征，提供其移位修复和重建手功能的解剖学参数。
设计、时间及地点：于2007-07/12在上海交通大学附属第六人民医院进行非随机对照实验。
材料：22侧冷冻成人手腕标本(男14侧，女8侧；左10侧，右12侧)，由上海交通大学附属第六人民医院显微外科研究所实验室提供。
方法：解剖观测钩骨第5掌腕关节面和近节指骨基底关节面的形态、结构特点，测量各关节面的尺桡径、掌背径、关节面凹面的深度及关节面面积。
主要观察指标：比较钩骨第5掌腕关节面和近节指骨基底关节面在形态、结构特点、面积及各径线长度的相似度。
结果：①钩骨第5掌腕关节面呈类椭圆形，中央凹陷，尺桡径短，掌背径长。各近节指骨底关节面形态近似，近节指骨基底关节面尺桡径长，掌背径短。②钩骨第5掌腕关节面的尺桡径和示、中指近节指骨基底关节面的掌背径相比，差异无显著性(P > 0.01)；掌背径和近节指骨基底关节面的尺桡径相比，差异显著（P < 0.01）；凹面深度和拇、示、中指近节指骨基底关节面的凹面深度相比，差异无显著性（P > 0.01）；面积和环指近节指骨基底关节面面积相比，差异无显著性（P > 0.01）。
结论：钩骨第5掌腕关节面可作为一个新的良好关节供区，用于修复和重建各近节指骨基底关节面。
关键词：腕掌关节；近节指骨；应用解剖；组织构建
王海明，范存义，姜佩珠，蔡培华，王金武，曾炳芳. 钩骨第5掌腕关节面的解剖学特征[J].中国组织工程研究与临床康复，2008，12(15):2866-2869 [www.zglckf.com/zglckf/ejournal/upfiles/08-15/15k-2866(ps).pdf]
上海市交通大学医学院，上海市
200025
王海明，男，1976年生，上海市人，汉族，2000年上海第二医科大学毕业，主治医师，主要从事骨科创伤的研究。
whmshly@126.com
中图分类号:R322.71
文献标识码:B
文章编号:1673-8225
(2008)15-02866-04
收稿日期：2008-01-04 修回日期：2008-03-10 (08-50-1-56/WL·Q)
Anatomical characteristics of the fifth carpometacarpal joint of the hamatum
Abstract
BACKGROUND: Whether the 5th carpometacarpal (CMC) joint of the hamatum can be a donor for hand bone defect transplantation.
OBJECTIVE: To offer the anatomic basis of the repair and reconstruction of hand joint by analyzing the anatomic characteristics of the 5th CMC joint of the hamatum.
DESIGN, TIME AND SETTING: A non-randomized control study was performed at the Sixth People's Hospital Affiliated to Shanghai JiaoTong University from July to December 2007.
MATERIALS: A total of 22 fresh frozen adult wrist specimens (14 males, 8 females, 10 left sides, 12 right sides) were provided by Laboratory of Institute of Microsurgery of Sixth People's Hospital of Shanghai Jiao Tong University.
METHODS: The morphous and structure of the 5th CMC joints of the hamatum and the base joints of the proximal phalanx were observed on the anatomic characteristics. The dorsal metacarpal diameter, radioulnar diameter, concave depth and area of the joints were measured.
MAIN OUTCOME MEASURES: Resemblance of the joints in morphous, structure, area and length of the 5th CMC joints of the hamatum and the base joints of the proximal phalanx.
RESULTS: ①The 5th CMC joints of the hamatum was similar to oval, its center was concave, its dorsal metacarpal diameter was longer than radioulnar diameter. The base joints of the proximal phalanx were also similar, and its dorsal metacarpal diameter was shorter than radioulnar diameter. ②The radioulnar diameter of the 5th CMC joints of the hamatum in the forefinger and middle finger had no significant difference compared to the dorsal metacarpal diameter of the base joints of the proximal phalanx (P > 0.01). There were significant differences between dorsal metacarpal diameter and radioulnar diameter of the base joints of the proximal phalanx (P < 0.01). There was no significant difference in concave depth in the thumb, forefinger and middle fingers (P > 0.01). There was no significant difference in area compared to the base joints of the proximal phalanx of the ring finger (P > 0.01).
CONCLUSION: The 5th CMC joint of the hamatum can be considered to be a new and well joint donor site, and it can be used to repair and reconstruct the base joints of the proximal phalanx.
Wang HM, Fan CY, Jiang PZ, Cai PH, Wang JW, Zeng BF. Anatomical characteristics of the fifth carpometacarpal joint of the hamatum.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu 2008;12(15):2866-2869(China)
[www.zglckf.com/zglckf/ejournal/upfiles/08-15/15k-2866(ps).pdf]
Medical College, Shanghai Jiao Tong University, Shanghai 200025, China
Wang Hai-ming, Attending physician, Medical College, Shanghai Jiao Tong University, Shanghai 200025, China
whmshly@126.com
Received: 2008-01-04
Accepted: 2008-03-10
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