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力学进展 ›› 2005, Vol. 35 ›› Issue (4): 472-480.doi: 10.6052/1000-0992-2005-4-J2005-054

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腕管综合征及其生物力学研究进展

郭欣;樊瑜波;李宗明   

  1. 四川大学生物力学工程实验室
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2005-12-10 发布日期:1900-01-01

CARPAL TUNNEL SYNDROME AND BIO-MECHANICAL STUDIES ON CTS

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  1. 四川大学生物力学工程实验室
  • Received:1900-01-01 Revised:1900-01-01 Online:2005-12-10 Published:1900-01-01

摘要: 腕管综合征(carpal tunnel syndrome, CTS)是腕部正中神经受到卡压而引起的一种神经病症. 它所带来的高昂的社会和 经济花费使得腕管综合征的研究应运而生, 并且在过去的10年里得到突飞猛进的发展. 常规 的手术方式是将腕横韧带(transverse carpal ligament)切开, 以释放正中神经(median nerve)所受到的压力. 本文不仅对腕管的解剖结构、腕管综合征的症状和发病机理、以及 诊断和治疗等方面作了简要概述, 还主要从以下几个方面探讨了近年来与腕管综合征相关的生物力学研究工作及其进 展: (1)影响腕管内压力的因素,包括腕部姿势, 手指、肌腱或手掌所受外荷载的大小, 以及手工劳 作的不同频率等; (2)腕管结构的稳定性研究, 如切开腕横韧带或腕骨间掌横韧带对腕刚度 的影响, 以及从动力学角度分析腕管减压手术会导致的腕骨失稳现象; (3)腕管内容物(如 肌腱、正中神经)的运动及内容物之间以及腕管内容物与腕横韧带之间的相互作用; (4)腕 横韧带的延展实验, 如利用外荷载或移位搭接的方法拉长腕横韧带, 以达到降低腕管内压力 的目的. 本文旨在加强人们对腕管综合征尤其是对与腕管综合征相关的生物力学研究进展的 了解, 并从生物力学的观点提出利用有限元方法对腕管结构进行三维建模与分析将有可能成 为腕管综合征进一步研究的一个重要发展方向.

关键词: 腕管综合征, 生物力学, 有限元方法, 腕横韧带, 正中神经

Abstract: Carpal tunnel syndrome (CTS) is defined as an entrapment neuropathy of the median nerve, and its high social and economic costs lead to a surge of studies, especially during the past ten years. This article first reviews normal anatomy of carpal tunnel, symptoms, causal factors and compression mechanism of CTS, and the diagnosis and treatment available for CTS patients. Then it gives a detailed review of the biomechanical studies related to carpal tunnel syndrome from the following aspects: (1) Factors affecting the carpal tunnel pressure, such as different wrist postures, loads on finger tips or tendons or palms, and the frequency of wrist movement in repetitive hand activities; (2) Carpal stability, such as the influence of incising the transverse carpal ligament or some transverse intercarpal ligament on carpal stiffness, and the loss of stability caused by the open carpal tunnel release as viewed in kinetics; (3) Movements and interactions between the digital flexor tendons, median nerve and transverse carpal ligament; (4) Lengthening of transverse carpal ligament by sustained tensile loads or using the transposition flap technique. The objective of this paper is to provide a basic understanding of CTS and to introduce the biomechanical studies that have been carrived out related to the CTS. It is suggested that one of promising aspects in biomechanical studies of CTS may lie in the use of finite element (FE) methods to set up three-dimensional models of the wrist and the hand and to analyze the carpal tunnel by biomechanics.

Key words: carpal tunnel syndrome (CTS), biomechanics, finite