CAJ | 학술논문

目的观察腕关节三角纤维软骨复合体(triangular fibocartilage 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解剖学依据.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.
목적 관찰완관절삼각섬유연골복합체(triangular fibocartilage complex,TFCC)적신경래원、내부신경분포,위완척측통제공병인기출,진이위기림상치료제공해부학의거.방법 대30례성년남성완관절표본진행해부,수선관찰완척측조직급TFCC적신경지배,지후관찰삼각섬유연골(triangular fibrocartilage,TFC)주위인대적조성급기지.최후선취10례표본,이용대서항인단극륭PGP9.5항체화Cy3표기적산양항대서IgG,통과면역형광염색기술,대TFCC내부신경분포행정량관찰.결과 TFCC적인대조성제포괄국내외보고적척월인대、척삼각인대(균저지우대응완골장측)、뇨척원측인대、척측부인대、척측완신기건초지외,환포괄척월、척삼각배측인대.완척측급TFCC적신경지배주요래자우척신경수배지적완관절지화전비내측피신경,이차주요분포우척측,우기시고유부(internal portion,IP).결론 TFCC적척월、척삼각인대불부지우대응완골적장측,동시야발출섬유저지우대응완골적배측.완척측급TFCC적신경지배주요래자우척신경수배지적완관절지화전비내측피신경,불수단일신경지배,기내부신경주요분포재척측,우기시IP,완고성척측완통가이행거신경지배술.
Objective To investigate the triangular fibrocartilage 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 × magnification.Structure,origin and attachment of the ligaments around triangular fibrocartilage (TFC) were also studied.Another 10 specimens were used to quantitatively study the innervation of TFCC via immunofluorescence technique using rat monoclonal anti-human PGP9.5 antibody and Cy3-conjugated goat anti-rat IgG. Results Ligaments around TFC included the ulnolunate ligament and ulnotriquetrum ligament,which both 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.Conclusion The ulnolunate and ulnotriquetrum ligaments attach both 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.