舟月骨间韧带分级切断对舟月间距的影响
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广东省科技攻关项目(A302020401)


Effect of Scapholunate Interosseous Ligament Sequential Sectioning on the Scapholunate Interval
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    摘要:

    目的了解舟月骨间韧带(SLIL)分级切断与舟月间距之间的关系,对SLIL各亚区在维持正常舟月骨位置关系中所起的作用进行评价,为临床上舟月骨分离的诊断提供参考。方法取新鲜冰冻上肢标本12具,以亚区为单位对SLIL进行分级切断,标本分为正常组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组;分别在腕关节处于应力位及非应力位、中立位与尺偏位时拍摄腕部X线片,测量各组标本舟月间隙宽度的变化。结果在各种拍摄条件下,切断SLIL近侧亚区对舟月间隙均未产生明显的影响;切断SLIL近+背侧亚区组、切断SLIL近+掌侧亚区组舟月间隙有所增宽,但没有统计学差异;在SLIL全切断组,舟月间隙增宽较为明显(P<0.05)。在切断SLIL近+背侧亚区组、切断SLIL近+掌侧亚区组及SLIL全切断组,对腕关节施以轴向100N的压力会使舟月间隙增宽更为明显,其中以SLIL全切断组增宽最为明显(P<0.01);与中立位比较,腕处于尺偏位时可使舟月间隙更宽,但并没有明显的差异(P>0.05)。结论SLIL近侧部分在维持正常舟月间距上不起关键作用;SLIL切断范围较大时,在腕部处于应力位时拍摄的X线片上可以更容易发现舟月间隙的异常,对舟月骨分离的诊断有一定的应用价值。

    Abstract:

    Objective This study evaluated the effects of sectioning the different scapholunate interosseous ligament(SLIL)subregions sequentially on the scapholunate interval, through which we can evaluate the role of different subregion of SLIL in maintain the normal scapholunate space, and provide a reference for the diagnosis of scapholunate dissociation. Method Twelve fresh cadaver upper extremities were used in this study. The wrist x-rays were taken in the intact state, after the proximal subregion of SLIL were cut, after the proximal and dorsal subregion of SLIL were cut, after the proximal and palmar subregion of SLIL were cut, after all of the SLIL were cut. Each x-rays were taken at neutral and ulnar deviation position, at rest and under stress. Scapholunate interval measurements were made at the mid-scapholunate joint. Comparison of the data was performed using one-way ANOVA. The level of significance was attributed to P<0.05. Results Sectioning of the proximal subregion of the SLIL did not change the scapholunate interval from the intact stage. Furthermore, additional sectioning of the dorsal or palmar subregion did not change scapholunate interval too. When the SLIL was sectioned completely, a small but statistically significant scapholunate interval change was noted. However, when the x-rays were taken at loaded wrist, the scapholunate intervals have significant changes compared with non-loaded wrist. The scapholunate interval has no significant difference between the neutral and ulnar position in all groups. Conclusions This study demonstrated that the proximal subregion of SLIL has no significant effect in maintaining the normal scapholunate relationship. When the SLIL was damaged severely, the abnormal scapholunate interval could be found more easily on wrist stress x-ray than non-stress x-ray. Thus, the x-ray taken at stress position was useful in the diagnosis of scaphoid lunate dissociation, especially when the SLIL was not damaged completely.

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李秀忠,赵卫东,文戈,刘阳,钟世镇.舟月骨间韧带分级切断对舟月间距的影响[J].医用生物力学,2005,20(1):1-4

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