tailieunhanh - Practical Plastic Surgery - part 8

Gân chèn FDS trên khía cạnh volar của đốt giữa, và chèn gân FDP vào khía cạnh volar của phalanx xa. FDS flexes PIP flexes doanh và FDP chủ yếu là các doanh DIP. Trong các chữ số, gân flexor đi trong đường hầm hoạt dịch lót được gọi là lớp vỏ flexor gân. Các lớp vỏ được neo vào xương bằng một loạt các năm ròng rọc hình khuyên, | Anatomy of the Hand 465 The tendon of FDS inserts on the volar aspect of the middle phalanx and the FDP tendon inserts on the volar aspect of the distal phalanx. FDS flexes the PIP joint and FDP flexes primarily the DIP joint. In the digits the flexor tendons travel in synovial-lined tunnels called flexor tendon sheaths. The sheaths are anchored to the bones by a series of five annular pulleys numbered A1-A5 from proximal to distal. The odd numbered pulleys are located over the joints the even pulleys lie over the bones. There are three thin cruciate pulleys numbered C1-C3 that maintain tendon motion and collapse during flexion. The palmer aponeurosis lies proximal to the A1 pulley and is often referred to as the A0 pulley. It acts in unison with the first two annular pulleys. Proximal to the entrance into the digital sheath A1 pulley the FDS tendon lies palmer to the FDP tendon. At this point the FDS tendon divides and becomes deep to the FDP tendon. The two portions reunite at Camper s chiasma and go on to attach to the middle phalanx. The FDP tendon after passing through the FDS bifurcation attaches to the distal phalanx. Flexor pollicis longus FPL is the primary flexor of the thumb. It is the most radial structure in the carpal tunnel. It travels in its own fibrous sheath in the palm and inserts into the base of the distal phalanx of the thumb. The thumb unlike the fingers has two annular pulleys A1 and A2 located over the MP and IP joints respectively. Lying between them is an oblique pulley that is the most important of these three pulleys. 77 Fingertip The fingertip is the end organ for touch enabling the hand to relay the shape temperature and texture of an object. The skin covering the pulp of the finger is very durable and has a thick epidermis with deep papillary ridges. The glabrous skin of the fingertip is well-suited for pinch and grasp functions. Its volar surface consists of a fatty pulp covered by highly innervated skin. The skin of the fingertip .

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