【作者】 刘乾仁；

【导师】 刘志刚；

【作者基本信息】 吉林大学 ， 外科学， 2011， 硕士

【摘要】 目的：TFCC作为一个韧带软骨复合体,对维系远端尺桡关节的稳定性具有重要作用,其损伤是尺侧腕痛的常见病因,并影响尺腕关节功能。通过对10例成人上肢标本的解剖和免疫荧光染色技术,对腕关节TFCC的神经来源、内部神经分布进行观察,为尺侧腕痛提供病因基础,进而为其临床治疗提供解剖学依据。方法：分别对2例成人新鲜标本和8例10%福尔马林固定的成人上肢标本进行显微解剖,10倍显微镜下观察TFCC的神经来源、分布。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。同时对几个切片进行HE染色,观察TFCC的大体结构。结果：通过标本的显微解剖发现,尺神经手背支和前臂内侧皮神经神经均有分支到腕关节尺侧,其中5例前臂内侧皮神经发1个分支至TFCC表面,3例有2个分支至TFCC;1例尺神经手背支发1个分支至TFCC,3例有2个分支,3例3个分支,3例4个分支。尺神经手背支和前臂内侧皮神经可同时支配TFCC。免疫荧光染色发现TFCC内神经主要分布在IP,桡侧没有神经分布。结论：TFCC的神经可来自于前臂内侧皮神经和尺神经手背支,不受单一神经支配,其内部神经主要分布在尺侧,尤其是IP部分,顽固性尺侧腕痛可以行去神经支配术。更多还原

【Abstract】 Objective:As a ligamentous and cartilaginous complex, TFCC plays an important role on sustaining the stability of distal radioulnar joint (DRUJ),injuries to the triangular fibrocartilage complex are a common cause of ulnar-sided wrist pain and affect the function of the ulnocarpal joint.By the dissection of 10 adult upper-extremity specimens and immunofluorescence technique, the study examined the nervous origin and the distribution of the TFCC of the wrist, and provided the etiopathogenisis basis of ulnar-sided wrist pain, furthermore, provided a proof for clinical treatment of ulnar-sided wrist pain.Methods:Two fresh adult upper-extremity specimens and ten adult upper-extremity specimens fixed by 10% formaldehyde were separately studied by microdissection, and we observed the nervous origin and the contribution of the TFCC at 10×magnification. The quantitative study observed the innervation of TFCC via immunofluorescence technique with rat monoclonal antihuman PGP 9.5 antibody and Cy3-marked goat antirat IgG.To study the general structure of the TFCC, meanwhile, several frozen sections were stained with hematoxylin and eosin.Results:The microdissection study showed that the dorsal branch of the ulnar nerve and the medial antebrachial cutaneous nerve both had branch to the ulnar side of the wrist.The medial antebrachial cutaneous nerve had one branch to the surface of TFCC in five specimens,and it had two branchs to TFCC in another three specimens. In ten specimens,articular branches to the TFCC arose from the dorsal branch of the ulnar nerve, one branch in one specimen, two branches in three specimens, three branches in three specimens, and four branches in three specimens. TFCC could be simultaneously innervated by the dorsal branch of the ulnar nerve and the medial antebrachial cutaneous nerve. Immunofluorescence showed that IP of TFCC was chiefly innervated, and the radial aspects were not innervated.Conclusion:Articular branches to the TFCC can arise from the medial antebrachial cutaneous nerve and the dorsal branch of the ulnar nerve,not single innervation. And they are predominantly located on the ulnar side of the TFCC, especially in the IP.Refractoriness ulnar-sided wrist pain can be performed a operation of denervation.更多还原