甲床根部与周围结构关系的解剖学研究

摘要

Objective :To provide morphological basis and reference for the clinical application through observing the relationship between the nail root and its adjacent structures .Methods :200 finger specimens were measured by the verni_er caliper with the accuracy of 0 .01 mm .Results :The mean distance from the proximal nail root to the terminal extensor tendon is 1 .42 ± 0 .09mm ;the mean length of the nail root is 4 .66 ± 0 .62 mm ;the mean distance from the proximal nail root of the thumb to the distal interphalangeal joint is 3 .11 ± 0 .59mm ;the length of all the other four fingers is 2 .80 ± 0 . 38mm ;the mean ratio of the thumb nail root to the distance from the proximal nail fold to the skin crease on the ventral of the finger during flexure of the distal interphalangeal joint is (31 .2 ± 4 .0)% ;the ratio of all the other four fingers is 39 .0 ± 5 .6% ;the nail root is a semioval arc-shaped surface to the proximal end ;the lateral extent of the nail root doesn't exceed the midlateral lines .Conclusion :When performing an ablation of the germinal matrix ,visualization of the termi_nal extensor tendon indicates that the proximal extent of the nail matrix has been reached and further proximal dissection is not required .The proximal nail fold 3-4mm can be excised to extend nail bed to achieve the goal of finger beauty .It is recommended that the excision of the nail matrix should be rectangular ,extending to the midlateral lines and the area which is 50% of the distance from the proximal nail fold to the skin crease on the ventral of the finger during flexure of the distal interphalangeal joint .As a rule ,a"ㄣ"shape incision should be operated on the dorsal skin of the finger tip ;the longitudinal part of the incision should be close to the midlateral lines as far as possible ;the transverse part of the incision should be in the skin crease on the dorsum of the finger during hyperextension of the joint .Thus ,the damage to the nail matrix can be avoided .%目的：观测甲床根部与周围结构的解剖学关系，为临床应用提供形态学依据。方法：用精度0．01 m m的游标卡尺对200只手指标本进行测量。结果：甲根近侧缘至指伸肌腱终腱止点的距离为（1．42±0．09）m m ；甲根部长度为（4．66±0．62）mm ；拇指甲根近侧缘至远侧指间关节距离为（3．11±0．59）mm ，其余四指为（2．80±0．38）mm ；拇指甲根长度占近端甲皱襞到远侧指间关节屈曲时掌侧皮肤皱褶水平距离的比例为（31．2±4．0）％，其余四指为（39．0±5．6）％；甲根部呈凸向近端的半椭圆形弧面，两边向侧方和掌面延伸，延伸的最大范围不超过手指侧中线。结论：手术切除甲基质时看到指伸肌腱终腱终止点，则提示近端切除范围已足够；可切除近端甲皱襞3～4 mm行甲床扩大术，以达到手指美观的目的；建议行甲基质切除术时切除范围可为两侧中线和近端甲皱襞到远侧指间关节屈曲时掌侧皮肤皱褶水平距离的50％；指端背侧手术切口一般采用“ㄣ”形切口，纵形切口部分尽量靠近两侧侧中线，横行部分以远侧指间关节背伸时皮肤皱褶处为宜，这样可避免损伤甲基质。