英汉对照骨科患者指南036：手部解剖

Hand Anatomy

手部解剖

A Patient’s Guide to Hand Anatomy

手部解剖患者指南

Introduction

引言

 

 

 

Few structures of the human anatomy are as unique as the hand. The hand needs to be mobile in order to position the fingers and thumb. Adequate strength forms the basis for normal hand function. The hand also must be coordinated to perform fine motor tasks with precision. The structures that form and move the hand require proper alignment and control in order for normal hand function to occur.

  　人体解剖结构中，手是独一无二的。手需要足够灵活来控制手指和拇指。手的正常功能基于合适的力量。精细动作的完成也需要手的配合。手的各个部分正常排列和相互协调才能正常发挥手的功能。

This guide will help you understand

· what parts make up the hand

· how those parts work together

　　本指南将帮助您了解

　　　· 手的组成

　　　· 手的各个部分是如何相互协调的

Important Structures

重要结构

The important structures of the hand can be divided into several categories. These include

· bones and joints

· ligaments and tendons

· muscles

· nerves

· blood vessels

　　手的重要结构可分成以下几种：

　　　· 骨与关节

　　　· 韧带与肌腱

　　　· 肌肉

　　　· 神经

　　　· 血管

The front, or palm-side, of the hand is referred to as the palmar side. The back of the hand is called the dorsal side.

　　手的前面或手掌面，定义为掌侧；手的后面定义为背侧。

Bones and Joints

骨与关节

 

There are 27 bones within the wrist and hand. The wrist itself contains eight small bones, called carpals. The carpals join with the two forearm bones, the radius and ulna, forming the wrist joint. Further into the palm, the carpals connect to the metacarpals. There are five metacarpals forming the palm of the hand. One metacarpal connects to each finger and thumb. Small bone shafts called phalanges　line up to form each finger and thumb.

　　手与腕部一共有27块骨头。其中，腕部拥有八块小骨头，叫做腕骨。腕骨与两块前臂骨头，尺骨与桡骨，共同形成腕关节。构成掌面的五块骨头叫掌骨，掌骨近侧与腕骨相连，五块掌骨远侧分别与相应的手指和拇指相连。手的远端一块块小的骨头又叫指骨，排列构成相应的手指和拇指。

The main knuckle joints are formed by the connections of the phalanges to the metacarpals. These joints are called the metacarpophalangeal joints (MCP joints). The MCP joints work like a hinge when you bend and straighten your fingers and thumb.

　　掌指关节(MCP joints)由掌骨与指骨连接构成，是手部的主要关节。当你做弯曲伸直手指和拇指动作的时候，掌指关节的作用就好比合页。

The three phalanges in each finger are separated by two joints, called interphalangeal joints (IP joints). The one closest to the MCP joint (knuckle) is called the proximal IP joint (PIP joint). The joint near the end of the finger is called the distal IP joint (DIP joint). The thumb only has one IP joint between the two thumb phalanges. The IP joints of the digits also work like hinges when you bend and straighten your fingers and thumb.

　　组成每个手指的三块指骨之间构成了两个关节，叫做指间关节（IP joints），其中靠近掌指关节的又叫近侧指间关节（PIP joint），靠近手指末端的则叫远侧指间关节（DIP joint）。而拇指由于只有两块指骨，因此只含有一个指间关节。同样的，当你做弯曲伸直手指和拇指动作的时候，指间关节的工作也类似合页。

The joints of the hand, fingers, and thumb are covered on the ends with articular cartilage. This white, shiny material has a rubbery consistency. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to　facilitate motion. There is articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate.

　　手的关节、手指和拇指的两端都覆盖着关节软骨。这种白色的有光泽的物质有着橡胶般的质地。关节软骨的作用包括吸收震荡以及在关节中提供非常光滑的表面以方便活动。基本上，两块骨头表面相互之间有活动，或构成关节的，都存在关节软骨。

Ligaments and Tendons

韧带和肌腱

Ligaments are tough bands of tissue that connect bones together. Two important structures, called collateral ligaments, are found on either side of each finger and thumb joint. The function of the collateral ligaments is to prevent abnormal sideways bending of each joint.

　　韧带是将骨头连接在一起的坚韧的束带组织。手指和拇指关节两侧各有一根重要的韧带，叫侧副韧带。侧副韧带的作用是为了防止各个关节异常的侧向弯曲。

In the PIP joint (the middle joint between the main knuckle and the DIP joint), the strongest ligament is the volar plate. This ligament connects the proximal phalanx to the middle phalanx on the palm side of the joint. The ligament tightens as the joint is straightened and keeps the PIP joint from bending back too far (hyperextending). Finger deformities can occur when the volar plate loosens from disease or injury.

　　在近侧指间关节（掌指关节和远侧指间关节中间的关节），最坚韧的韧带要数掌板。这个韧带在掌侧连接着近节指骨与中节指骨。随着近侧指间关节伸直，掌侧韧带板也变得绷紧，从而起到防止近侧指间关节过伸的作用。当掌板因病变或损伤松弛时，会出现手指畸形。

The tendons that allow each finger joint to straighten are called the extensor tendons. The extensor tendons of the fingers begin as muscles that arise from the backside of the forearm bones. These muscles travel towards the hand, where they eventually connect to the extensor tendons before crossing over the back of the wrist joint. As they travel into the fingers, the extensor tendons become the extensor hood. The extensor hood flattens out to cover the top of the finger and sends out branches on each side that connect to the bones in the middle and end of the finger.

　　使手指关节伸直的肌腱叫伸肌腱。这些伸肌腱开始于前臂骨背侧的肌肉。这些肌肉向手部延伸并最终在经过腕关节之前延续为伸肌腱。当这些肌腱延伸至手指时，形成了伸肌腱帽。扁平的伸肌键帽覆盖着手指的近端并在两侧发出分支连接中远节指骨。

The place where the extensor tendon attaches to the middle phalanx is called the central slip. When the extensor muscles contract, they tug on the extensor tendon and straighten the finger. Problems occur when the central slip is damaged, as can happen with a tear.

　　伸肌腱连接中指骨处叫做中央腱束。当伸肌收缩时，伸肌腱被牵拉从而伸直手指。当撕裂等原因导致中央腱束受损时，将出现问题。

Muscles

肌肉

Many of the muscles that control the hand start at the elbow or forearm. They run down the forearm and cross the wrist and hand. Some control only the bending or straightening of the wrist. Others influence motion of the fingers or thumb. Many of these muscles help position and hold the wrist and hand while the thumb and fingers grip or perform fine motor actions.

　　许多控制手部活动的肌肉起始于肘部或者前臂。他们沿前臂向下延伸跨越腕部或手部。一些肌肉只控制腕部的伸屈活动。另一些肌肉则影响着手指和拇指的运动。其中许多肌肉在手指和拇指做抓握和精细动作的时候起到维持手腕部位置的作用。

Most of the small muscles that work the thumb and pinky finger start on the carpal bones. These muscles connect in ways that allow the hand to grip and hold. Two muscles allow the thumb to move across the palm of the hand, an important function called thumb opposition.

　　大部分控制拇指和小指的小肌肉起于腕骨。这些肌肉相互联系来共同帮助手部进行抓握活动。其中拇指上有两块肌肉来帮助拇指做横跨手掌的动作，这个重要的功能叫拇指对掌。

 

 

 

The smallest muscles that originate in the wrist and hand are called the intrinsic muscles. The intrinsic muscles guide the fine motions of the fingers by getting the fingers positioned and holding them steady during hand activities.

　　源于腕部和手部的最小的肌肉叫做内在肌。内在肌通过在活动中维持手指的位置并保持稳定来帮助手指的精细运动。

Nerves

神经

 

 

All of the nerves that travel to the hand and fingers begin together at the shoulder: the radial nerve, the median nerve, and the ulnar nerve. These nerves carry signals from the brain to the muscles that move the arm, hand, fingers, and thumb. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.

　　所有手部的神经都来自于肩部：桡神经、正中神经以及尺神经。这些神经传达着来自脑部的电信号来控制手臂、手、手指和拇指的运动。同时这些神经也将感觉的电信号如触觉、痛觉和温觉传导回大脑。

The radial nerve runs along the thumb-side edge of the forearm. It wraps around the end of the radius bone toward the back of the hand. It gives sensation to the back of the hand from the thumb to the third finger. It also supplies the back of the thumb and just beyond the main knuckle of the back surface of the ring and middle fingers.

　　桡神经走形于前臂拇指侧。在桡骨末端，桡神经环绕前臂进而分布于手背。它传导着来自手背拇指到第三指之间区域的感觉。同时桡神经支配着拇指背侧和环指和中指掌指关节附近背侧的感觉。

The median nerve travels through a tunnel within the wrist called the carpal tunnel. This nerve gives sensation to the thumb, index finger, long finger, and half of the ring finger. It also sends a nerve branch to control the　thenar muscles of the thumb. The thenar muscles help move the thumb and let you touch the pad of the thumb to the tips each of each finger on the same hand, a motion called opposition.

　　正中神经在腕部穿行的隧道称为腕管。这根的神经感觉支配区域包括拇指、示指、中指以及一半环指。同时它还分出分支来支配拇指大鱼际肌的运动。大鱼际肌能够带动拇指活动，并且能够使您将大拇指腹与同侧各个指头间相互碰触，这个动作叫对指。

The ulnar nerve travels through a separate tunnel, called　Guyon’s canal. This tunnel is formed by two carpal bones, the pisiform and hamate, and the ligament that connects them. After passing through the canal, the ulnar nerve branches out to supply feeling to the little finger and half the ring finger. Branches of this nerve also supply the small muscles in the palm and the muscle that pulls the thumb toward the palm.

　　尺神穿行于一个独立的管道里，叫做Guyon管。Guyon管由两块腕骨，即豌豆骨和钩骨，以及附着的韧带共同组成。当尺神经穿过此管，发出神经支配小指以及环指尺侧半感觉。尺神经的分支也支配手掌面的小肌肉来帮助拇指做对掌运动。

The nerves that travel to the hand are subject to problems. Constant bending and straightening of the wrist and fingers can lead to irritation or pressure on the nerves within their tunnels and cause problems such as pain, numbness, and weakness in the hand, fingers, and thumb.

　　分布于手部的神经很容易受损。长期的重复的做腕部和手指的伸屈动作将会对管道里的神经产生刺激和挤压，最终导致手、手指、拇指的疼痛、麻木和无力。

Blood Vessels

血管

Traveling along with the nerves are the large vessels that supply the hand with blood. The largest artery is the radial artery that travels across the front of the wrist, closest to the thumb. The radial artery is where the pulse is taken in the wrist. The ulnar artery runs next to the ulnar nerve through Guyon’s canal (mentioned earlier). The ulnar and radial arteries arch together within the palm of the hand, supplying the front of the hand, fingers, and thumb. Other arteries travel across the back of the wrist to supply the back of the hand, fingers, and thumb.

　　为手部供血的大血管多与神经伴行。桡动脉是为手部供血的最大的动脉，它穿越腕部的前面，靠近拇指。腕部测脉搏的地方即为桡动脉。尺动脉在Guyon管（详见前文）与尺神经伴行。尺动脉和桡动脉吻合成掌浅弓和掌深弓动脉供应手、手指和拇指前方的血供。另外一些动脉则穿越腕背部为手、手指和拇指的背侧供血。

 

 

Summary

结语

The hand is formed of numerous structures that have an important role in normal hand function. Conditions that change the way these structures work can greatly impact whether the hand functions normally. When our hands are free of problems, it’s easy to take the complex anatomy of the hand for granted.

　　总而言之，手复杂的结构维持着手的正常的功能。任何破坏这些结构的情况都会影响手的正常功能。当我们拥有一双健康的正常的双手时，我们很容易忽视手复杂结构的重要性。

 

（胡小坚　翻译　　王跃　校对）

胡小坚，浙江大学附属第一医院2015级骨科临床型研究生。学习并研究脊柱退行性变疾患的流行病学、影像学和病理学。曾参加学习2016年AOSpine组织的Mentorship Research Program项目。

王跃，博士，骨科博士生导师，浙一医院脊柱微创中心副主任、脊柱实验室副主任。擅长各类脊柱疾患的诊治。专攻脊柱退行性变疾患的流行病学、影像学和病理学研究。在终板病损的分类及其在腰椎间盘退变以及下腰痛中作用、椎体骨组织-椎间盘之间的生理和病理作用、以及在腰椎MR量化测量等三方面做出来创新性的成果。近五年以一作或通讯作者发表SCI论文23篇。参编全球首部椎间盘专著The Intervertebral Disc. 发表国际性会议摘要20余篇，作口头学术报告16次，受邀请学术报告4次。2016年6月因对终板的杰出研究获脊柱研究最高国际学术荣誉、国际腰椎学会奖ISSLS奖，成为ISSLS颁奖30余年以来首位来自中国大陆的获奖者。主持AOSpine基金2项，国家自然科学基金1项，浙江省海外高层次人才创新园创业项目1项，省级厅级项目8项。2015年入选浙江省钱江人才计划。现为AOSpine，国际腰椎学会（ISSLS）会员，Bone、Spine、European Spine Journal等多个国际杂志审稿人。

  

编辑：胡佰文