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.

  　人體解剖結(jié)構(gòu)中，手是獨(dú)一無二的,。手需要足夠靈活來控制手指和拇指,。手的正常功能基于合適的力量,。精細(xì)動作的完成也需要手的配合,。手的各個部分正常排列和相互協(xié)調(diào)才能正常發(fā)揮手的功能,。

This guide will help you understand

· what parts make up the hand

· how those parts work together

　　本指南將幫助您了解

　　　· 手的組成

　　　· 手的各個部分是如何相互協(xié)調(diào)的

Important Structures

重要結(jié)構(gòu)

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

· bones and joints

· ligaments and tendons

· muscles

· nerves

· blood vessels

　　手的重要結(jié)構(gòu)可分成以下幾種：

　　　· 骨與關(guān)節(jié)

　　　· 韌帶與肌腱

　　　· 肌肉

　　　· 神經(jīng)

　　　· 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,，定義為掌側(cè),；手的后面定義為背側(cè),。

Bones and Joints

骨與關(guān)節(jié)

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.

　　手與腕部一共有27塊骨頭。其中,，腕部擁有八塊小骨頭,，叫做腕骨。腕骨與兩塊前臂骨頭,，尺骨與橈骨,，共同形成腕關(guān)節(jié)。構(gòu)成掌面的五塊骨頭叫掌骨,，掌骨近側(cè)與腕骨相連,，五塊掌骨遠(yuǎn)側(cè)分別與相應(yīng)的手指和拇指相連。手的遠(yuǎn)端一塊塊小的骨頭又叫指骨,，排列構(gòu)成相應(yīng)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.

　　掌指關(guān)節(jié)(MCP joints)由掌骨與指骨連接構(gòu)成，是手部的主要關(guān)節(jié)。當(dāng)你做彎曲伸直手指和拇指動作的時候,，掌指關(guān)節(jié)的作用就好比合頁,。

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.

　　組成每個手指的三塊指骨之間構(gòu)成了兩個關(guān)節(jié)，叫做指間關(guān)節(jié)（IP joints）,，其中靠近掌指關(guān)節(jié)的又叫近側(cè)指間關(guān)節(jié)（PIP joint）,，靠近手指末端的則叫遠(yuǎn)側(cè)指間關(guān)節(jié)（DIP joint）。而拇指由于只有兩塊指骨,，因此只含有一個指間關(guān)節(jié),。同樣的，當(dāng)你做彎曲伸直手指和拇指動作的時候,，指間關(guān)節(jié)的工作也類似合頁,。

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.

　　手的關(guān)節(jié)、手指和拇指的兩端都覆蓋著關(guān)節(jié)軟骨,。這種白色的有光澤的物質(zhì)有著橡膠般的質(zhì)地,。關(guān)節(jié)軟骨的作用包括吸收震蕩以及在關(guān)節(jié)中提供非常光滑的表面以方便活動?；旧?，兩塊骨頭表面相互之間有活動，或構(gòu)成關(guān)節(jié)的,，都存在關(guān)節(jié)軟骨,。

Ligaments and Tendons

韌帶和肌腱

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.

　　韌帶是將骨頭連接在一起的堅韌的束帶組織。手指和拇指關(guān)節(jié)兩側(cè)各有一根重要的韌帶,，叫側(cè)副韌帶,。側(cè)副韌帶的作用是為了防止各個關(guān)節(jié)異常的側(cè)向彎曲。

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.

　　在近側(cè)指間關(guān)節(jié)（掌指關(guān)節(jié)和遠(yuǎn)側(cè)指間關(guān)節(jié)中間的關(guān)節(jié)）,，最堅韌的韌帶要數(shù)掌板,。這個韌帶在掌側(cè)連接著近節(jié)指骨與中節(jié)指骨。隨著近側(cè)指間關(guān)節(jié)伸直,，掌側(cè)韌帶板也變得繃緊,，從而起到防止近側(cè)指間關(guān)節(jié)過伸的作用。當(dāng)掌板因病變或損傷松弛時,，會出現(xiàn)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.

　　使手指關(guān)節(jié)伸直的肌腱叫伸肌腱。這些伸肌腱開始于前臂骨背側(cè)的肌肉,。這些肌肉向手部延伸并最終在經(jīng)過腕關(guān)節(jié)之前延續(xù)為伸肌腱,。當(dāng)這些肌腱延伸至手指時，形成了伸肌腱帽,。扁平的伸肌鍵帽覆蓋著手指的近端并在兩側(cè)發(fā)出分支連接中遠(yuǎn)節(jié)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.

　　伸肌腱連接中指骨處叫做中央腱束,。當(dāng)伸肌收縮時，伸肌腱被牽拉從而伸直手指,。當(dāng)撕裂等原因?qū)е轮醒腚焓軗p時,，將出現(xiàn)問題。

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.

　　許多控制手部活動的肌肉起始于肘部或者前臂,。他們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動。另一些肌肉則影響著手指和拇指的運(yùn)動,。其中許多肌肉在手指和拇指做抓握和精細(xì)動作的時候起到維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。這些肌肉相互聯(lián)系來共同幫助手部進(jìn)行抓握活動,。其中拇指上有兩塊肌肉來幫助拇指做橫跨手掌的動作,，這個重要的功能叫拇指對掌。

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內(nèi)在肌,。內(nèi)在肌通過在活動中維持手指的位置并保持穩(wěn)定來幫助手指的精細(xì)運(yùn)動。

Nerves

神經(jīng)

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.

　　所有手部的神經(jīng)都來自于肩部：橈神經(jīng),、正中神經(jīng)以及尺神經(jīng),。這些神經(jīng)傳達(dá)著來自腦部的電信號來控制手臂、手,、手指和拇指的運(yùn)動,。同時這些神經(jīng)也將感覺的電信號如觸覺、痛覺和溫覺傳導(dǎo)回大腦,。

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.

　　橈神經(jīng)走形于前臂拇指側(cè),。在橈骨末端，橈神經(jīng)環(huán)繞前臂進(jìn)而分布于手背,。它傳導(dǎo)著來自手背拇指到第三指之間區(qū)域的感覺,。同時橈神經(jīng)支配著拇指背側(cè)和環(huán)指和中指掌指關(guān)節(jié)附近背側(cè)的感覺。

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.

　　正中神經(jīng)在腕部穿行的隧道稱為腕管,。這根的神經(jīng)感覺支配區(qū)域包括拇指,、示指、中指以及一半環(huán)指,。同時它還分出分支來支配拇指大魚際肌的運(yùn)動,。大魚際肌能夠帶動拇指活動，并且能夠使您將大拇指腹與同側(cè)各個指頭間相互碰觸,，這個動作叫對指,。

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.

　　尺神穿行于一個獨(dú)立的管道里，叫做Guyon管,。Guyon管由兩塊腕骨,，即豌豆骨和鉤骨，以及附著的韌帶共同組成。當(dāng)尺神經(jīng)穿過此管,，發(fā)出神經(jīng)支配小指以及環(huán)指尺側(cè)半感覺,。尺神經(jīng)的分支也支配手掌面的小肌肉來幫助拇指做對掌運(yùn)動。

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.

　　分布于手部的神經(jīng)很容易受損,。長期的重復(fù)的做腕部和手指的伸屈動作將會對管道里的神經(jīng)產(chǎn)生刺激和擠壓,，最終導(dǎo)致手、手指,、拇指的疼痛,、麻木和無力。

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.

　　為手部供血的大血管多與神經(jīng)伴行,。橈動脈是為手部供血的最大的動脈,，它穿越腕部的前面，靠近拇指,。腕部測脈搏的地方即為橈動脈,。尺動脈在Guyon管（詳見前文）與尺神經(jīng)伴行。尺動脈和橈動脈吻合成掌淺弓和掌深弓動脈供應(yīng)手,、手指和拇指前方的血供,。另外一些動脈則穿越腕背部為手、手指和拇指的背側(cè)供血,。

Summary

結(jié)語

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.

　　總而言之,，手復(fù)雜的結(jié)構(gòu)維持著手的正常的功能。任何破壞這些結(jié)構(gòu)的情況都會影響手的正常功能,。當(dāng)我們擁有一雙健康的正常的雙手時,，我們很容易忽視手復(fù)雜結(jié)構(gòu)的重要性。

（胡小堅　翻譯　　王躍　校對）

胡小堅,，浙江大學(xué)附屬第一醫(yī)院2015級骨科臨床型研究生,。學(xué)習(xí)并研究脊柱退行性變疾患的流行病學(xué)、影像學(xué)和病理學(xué),。曾參加學(xué)習(xí)2016年AOSpine組織的Mentorship Research Program項(xiàng)目,。

王躍，博士,，骨科博士生導(dǎo)師,，浙一醫(yī)院脊柱微創(chuàng)中心副主任、脊柱實(shí)驗(yàn)室副主任,。擅長各類脊柱疾患的診治,。專攻脊柱退行性變疾患的流行病學(xué)、影像學(xué)和病理學(xué)研究,。在終板病損的分類及其在腰椎間盤退變以及下腰痛中作用,、椎體骨組織-椎間盤之間的生理和病理作用,、以及在腰椎MR量化測量等三方面做出來創(chuàng)新性的成果。近五年以一作或通訊作者發(fā)表SCI論文23篇,。參編全球首部椎間盤專著The Intervertebral Disc. 發(fā)表國際性會議摘要20余篇,，作口頭學(xué)術(shù)報告16次，受邀請學(xué)術(shù)報告4次,。2016年6月因?qū)K板的杰出研究獲脊柱研究最高國際學(xué)術(shù)榮譽(yù),、國際腰椎學(xué)會獎ISSLS獎，成為ISSLS頒獎30余年以來首位來自中國大陸的獲獎?wù)?。主持AOSpine基金2項(xiàng),，國家自然科學(xué)基金1項(xiàng)，浙江省海外高層次人才創(chuàng)新園創(chuàng)業(yè)項(xiàng)目1項(xiàng),，省級廳級項(xiàng)目8項(xiàng),。2015年入選浙江省錢江人才計劃。現(xiàn)為AOSpine,，國際腰椎學(xué)會（ISSLS）會員,，Bone、Spine,、European Spine Journal等多個國際雜志審稿人,。

編輯：胡佰文