中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2007年
22期
4436-4439
,共4页
刘晓伟%白桂有%王炳胜%张正治%孙华%鲁传东
劉曉偉%白桂有%王炳勝%張正治%孫華%魯傳東
류효위%백계유%왕병성%장정치%손화%로전동
手掌部筋膜间隙%三维重建%解剖学
手掌部觔膜間隙%三維重建%解剖學
수장부근막간극%삼유중건%해부학
背景:由于手掌部筋膜间隙是潜在的非实质性结构,容易给手掌部筋膜间隙疾病的诊断和治疗带来困难.为了达到对手掌部筋膜间隙疾病的准确诊断和良好治疗,有必要对其解剖境界和毗邻关系充分理解.目的:通过新鲜尸体标本解剖并结合薄层断面解剖及计算机图像识别技术对手掌部筋膜间隙的边界和毗邻关系进行观察,并利用计算机三维重建技术对其进行重建,以便更好地显示手掌部筋膜间隙的毗邻关系,为手掌部筋膜间隙疾病的影像学诊断和外科手术提供详实的解剖学依据.设计:重复测量设计.单位:解放军第二五一医院和第三军医大学中心实验室.材料:选用成人新鲜手标本12只(保留腕关节,标本由第三军医大学解剖教研室提供),左、右各6只,肉眼观察无明显器质性损害.将其中2只(左、右各1只),进行薄层断面解剖和图像重建.其余10只手进行大体解剖学观察.方法:实验于2003-05/2006-02在解放军第三军医大学中心实验室及解放军第二五一医院完成.应用大体解剖学、断层解剖学、可视人及虚拟人技术理论,通过进行标本的大体解剖学、断层解剖学观察,并在微型计算机进行手掌部筋膜间隙的重建计算机三维重建.主要观察指标:手掌部筋膜间隙的解剖学境界和毗邻关系.结果:新鲜尸体解剖并结合薄层断面解剖及计算机图像识别技术和三维重建技术对掌中间隙和鱼际间隙的毗邻及范围的观察结果显示:掌中间隙的前界自尺侧起为掌内侧肌腱隔及其周围的深筋膜、尺侧3指指屈肌腱的腱鞘及第2～4蚓状肌、示指屈肌腱鞘与中指屈肌腱鞘之间的深筋膜;后界为骨间掌侧肌表面的骨间掌侧筋膜及拇收肌表面的拇收肌筋膜;尺侧界为掌内侧肌腱隔及部分骨间掌侧筋膜;桡侧界为掌中隔;远侧分为3个小间隙,沿各自小间隙内的蚓状肌鞘通向2,3,4指蹼间隙;近侧经腕管与前臂屈肌后间隙相通.鱼际间隙的前界至尺侧起为示指屈肌腱鞘及第1蚓状肌、掌深筋膜和掌外侧肌腱隔;后界为拇收肌筋膜;桡侧界为拇长屈肌腱及其腱鞘、掌深筋膜;尺侧界为掌中隔;远侧沿第1蚓状肌鞘通向第1指蹼间隙;近侧为盲端.结论:鱼际间隙的近端为盲端,掌中间隙的远端分为3个小间隙,手掌部筋膜间隙的计算机三维重建对于该区域疾病的影像学诊断和外科手术具有重要意义.
揹景:由于手掌部觔膜間隙是潛在的非實質性結構,容易給手掌部觔膜間隙疾病的診斷和治療帶來睏難.為瞭達到對手掌部觔膜間隙疾病的準確診斷和良好治療,有必要對其解剖境界和毗鄰關繫充分理解.目的:通過新鮮尸體標本解剖併結閤薄層斷麵解剖及計算機圖像識彆技術對手掌部觔膜間隙的邊界和毗鄰關繫進行觀察,併利用計算機三維重建技術對其進行重建,以便更好地顯示手掌部觔膜間隙的毗鄰關繫,為手掌部觔膜間隙疾病的影像學診斷和外科手術提供詳實的解剖學依據.設計:重複測量設計.單位:解放軍第二五一醫院和第三軍醫大學中心實驗室.材料:選用成人新鮮手標本12隻(保留腕關節,標本由第三軍醫大學解剖教研室提供),左、右各6隻,肉眼觀察無明顯器質性損害.將其中2隻(左、右各1隻),進行薄層斷麵解剖和圖像重建.其餘10隻手進行大體解剖學觀察.方法:實驗于2003-05/2006-02在解放軍第三軍醫大學中心實驗室及解放軍第二五一醫院完成.應用大體解剖學、斷層解剖學、可視人及虛擬人技術理論,通過進行標本的大體解剖學、斷層解剖學觀察,併在微型計算機進行手掌部觔膜間隙的重建計算機三維重建.主要觀察指標:手掌部觔膜間隙的解剖學境界和毗鄰關繫.結果:新鮮尸體解剖併結閤薄層斷麵解剖及計算機圖像識彆技術和三維重建技術對掌中間隙和魚際間隙的毗鄰及範圍的觀察結果顯示:掌中間隙的前界自呎側起為掌內側肌腱隔及其週圍的深觔膜、呎側3指指屈肌腱的腱鞘及第2～4蚓狀肌、示指屈肌腱鞘與中指屈肌腱鞘之間的深觔膜;後界為骨間掌側肌錶麵的骨間掌側觔膜及拇收肌錶麵的拇收肌觔膜;呎側界為掌內側肌腱隔及部分骨間掌側觔膜;橈側界為掌中隔;遠側分為3箇小間隙,沿各自小間隙內的蚓狀肌鞘通嚮2,3,4指蹼間隙;近側經腕管與前臂屈肌後間隙相通.魚際間隙的前界至呎側起為示指屈肌腱鞘及第1蚓狀肌、掌深觔膜和掌外側肌腱隔;後界為拇收肌觔膜;橈側界為拇長屈肌腱及其腱鞘、掌深觔膜;呎側界為掌中隔;遠側沿第1蚓狀肌鞘通嚮第1指蹼間隙;近側為盲耑.結論:魚際間隙的近耑為盲耑,掌中間隙的遠耑分為3箇小間隙,手掌部觔膜間隙的計算機三維重建對于該區域疾病的影像學診斷和外科手術具有重要意義.
배경:유우수장부근막간극시잠재적비실질성결구,용역급수장부근막간극질병적진단화치료대래곤난.위료체도대수장부근막간극질병적준학진단화량호치료,유필요대기해부경계화비린관계충분리해.목적:통과신선시체표본해부병결합박층단면해부급계산궤도상식별기술대수장부근막간극적변계화비린관계진행관찰,병이용계산궤삼유중건기술대기진행중건,이편경호지현시수장부근막간극적비린관계,위수장부근막간극질병적영상학진단화외과수술제공상실적해부학의거.설계:중복측량설계.단위:해방군제이오일의원화제삼군의대학중심실험실.재료:선용성인신선수표본12지(보류완관절,표본유제삼군의대학해부교연실제공),좌、우각6지,육안관찰무명현기질성손해.장기중2지(좌、우각1지),진행박층단면해부화도상중건.기여10지수진행대체해부학관찰.방법:실험우2003-05/2006-02재해방군제삼군의대학중심실험실급해방군제이오일의원완성.응용대체해부학、단층해부학、가시인급허의인기술이론,통과진행표본적대체해부학、단층해부학관찰,병재미형계산궤진행수장부근막간극적중건계산궤삼유중건.주요관찰지표:수장부근막간극적해부학경계화비린관계.결과:신선시체해부병결합박층단면해부급계산궤도상식별기술화삼유중건기술대장중간극화어제간극적비린급범위적관찰결과현시:장중간극적전계자척측기위장내측기건격급기주위적심근막、척측3지지굴기건적건초급제2～4인상기、시지굴기건초여중지굴기건초지간적심근막;후계위골간장측기표면적골간장측근막급무수기표면적무수기근막;척측계위장내측기건격급부분골간장측근막;뇨측계위장중격;원측분위3개소간극,연각자소간극내적인상기초통향2,3,4지복간극;근측경완관여전비굴기후간극상통.어제간극적전계지척측기위시지굴기건초급제1인상기、장심근막화장외측기건격;후계위무수기근막;뇨측계위무장굴기건급기건초、장심근막;척측계위장중격;원측연제1인상기초통향제1지복간극;근측위맹단.결론:어제간극적근단위맹단,장중간극적원단분위3개소간극,수장부근막간극적계산궤삼유중건대우해구역질병적영상학진단화외과수술구유중요의의.
BACKGROUND: The metacarpal fascial spaces of hand are the potential structure that is not virtual, so that difficulties are presented in diagnosis and treatment of diseases of the metacarpal fascial spaces of hand. In order to solve the difficulties,anatomical borderline and abut relationship of the metacarpal fascial spaces of hand have to be sufficiently understood. OBJECTIVE: The borderline and abut of the metacarpal fascial spaces of hand were detailedly observed and researched by fresh cadaveric dissection, thin sectional anatomy and computer image recognition technology, and the 3-D reconstruction technology was utilized to reconstructed the metacarpal fascial spaces in this paper, so the abut relationship of the metacarpal fascial spaces of hand could be displayed, and the detailed anatomical data of imaging diagnosis and surgical treatments of disease of the fascial spaces of hand could be provided. DESIGN: Repeated measuring design.SETTING: The 251 Hospital of Chinese PLA and Central Laboratory of the Third Military Medical University of Chinese PLA. MATERIALS: Twelve adult fresh cadaveric hands which involved six right hands and six left hands and wrist joint, had no organic damage by naked observation, provided by the Department of Anatomy, the Third Military Medical University of Chinese PLA, among one right hand and one left hand were waiting for being mill-cut and thin cross-section dissected and imaging reconstructed. Among ten hands were observed by fresh cadaveric anatomy. METHODS: The trial was carried out in the 251 Hospital of Chinese PLA and Central Laboratory and Department of Anatomy of the Third Military Medical University of Chinese PLA from May 2003 to February 2006. Based on the gross anatomy, thin cross-section anatomy, visible human and virtual human technology theory, the metacarpal fascial spaces of hand were three-D reconstructed in microcomputer.MAIN OUTCOME MEASURES: Anatomical borderline and about relation of the metacarpal fascial spaces of hand. RESULTS: Display of observation result of adjacent and dimension of the midpalmar space and the thenar space by fresh cadaveric anatomy combined with thin cross-section anatomy, computer image recognition technology, and the 3-D reconstruction technology: The anterior borderline of the MPS was the digital flexor tendons of middle finger, ring finger, little finger and the 2nd lumbrical muscle (LM), 3rd LM, 4th LM; the posterior borderline was the palmar interosseous fascia before 3rd palmar bone, 4th palmar bone, 5th palmar bone and corresponding interosseous muscles; the lateral borderline was the palmar intermediate septum; the medial borderline of the MPS was the medial intermuscular septum of palm. In addition, the distal section of the MPS which was separated into three little spaces by two septums of connective tissue, and 3rd 4th, 5th digital flexor tendon and 2nd, 3rd, 4th LM were respectively contained by the three little spaces. The proximal of this space opened to the posterior space of antebrachial flexor by the carpal canal; the distal of this space opened to 2nd, 3rd, 4th web space (WS) by 2nd, 3rd, compartment of 4th LM, and continuously the dorsal subcutaneous space and the subaponeurotic space. The anterior borderline of the TS was the 1st digital flexor tendon and the 1st LM; the posterior borderline was the fascia of abductor pollicis; the medial borderline was the palmar intermediate septum (PIMS); the lateral borderline was the tenden sheath of flexor pollicis longus and the lateral intermuscular septum of palm. The distal of this space opened to 1st WS by compartment of the 1st LM, and continuously to the dorsal subcutaneous space and the subaponeurotic space; the proximal of the TS was close.CONCLUSION: The proximal of the thenar space is close, the distal section of the metacarpal fascial spaces is separated into three little spaces, and the computerized three-D renconstruction of the fascial spaces of hand can provide some guidance for imaging diagnosis and surgical treatments.
