ABSTRACT
BACKGROUND: The metacarpal fascial spaces of hand are the potential structure that is not virtual, so that difficulties are presented in diagnosis and treatment of diseases of the metacarpal fascial spaces of hand. In order to solve the difficulties,anatomical borderline and abut relationship of the metacarpal fascial spaces of hand have to be sufficiently understood. OBJECTIVE: The borderline and abut of the metacarpal fascial spaces of hand were detailedly observed and researched by fresh cadaveric dissection, thin sectional anatomy and computer image recognition technology, and the 3-D reconstruction technology was utilized to reconstructed the metacarpal fascial spaces in this paper, so the abut relationship of the metacarpal fascial spaces of hand could be displayed, and the detailed anatomical data of imaging diagnosis and surgical treatments of disease of the fascial spaces of hand could be provided. DESIGN: Repeated measuring design.SETTING: The 251 Hospital of Chinese PLA and Central Laboratory of the Third Military Medical University of Chinese PLA. MATERIALS: Twelve adult fresh cadaveric hands which involved six right hands and six left hands and wrist joint, had no organic damage by naked observation, provided by the Department of Anatomy, the Third Military Medical University of Chinese PLA, among one right hand and one left hand were waiting for being mill-cut and thin cross-section dissected and imaging reconstructed. Among ten hands were observed by fresh cadaveric anatomy. METHODS: The trial was carried out in the 251 Hospital of Chinese PLA and Central Laboratory and Department of Anatomy of the Third Military Medical University of Chinese PLA from May 2003 to February 2006. Based on the gross anatomy, thin cross-section anatomy, visible human and virtual human technology theory, the metacarpal fascial spaces of hand were three-D reconstructed in microcomputer.MAIN OUTCOME MEASURES: Anatomical borderline and about relation of the metacarpal fascial spaces of hand. RESULTS: Display of observation result of adjacent and dimension of the midpalmar space and the thenar space by fresh cadaveric anatomy combined with thin cross-section anatomy, computer image recognition technology, and the 3-D reconstruction technology: The anterior borderline of the MPS was the digital flexor tendons of middle finger, ring finger, little finger and the 2nd lumbrical muscle (LM), 3rd LM, 4th LM; the posterior borderline was the palmar interosseous fascia before 3rd palmar bone, 4th palmar bone, 5th palmar bone and corresponding interosseous muscles; the lateral borderline was the palmar intermediate septum; the medial borderline of the MPS was the medial intermuscular septum of palm. In addition, the distal section of the MPS which was separated into three little spaces by two septums of connective tissue, and 3rd 4th, 5th digital flexor tendon and 2nd, 3rd, 4th LM were respectively contained by the three little spaces. The proximal of this space opened to the posterior space of antebrachial flexor by the carpal canal; the distal of this space opened to 2nd, 3rd, 4th web space (WS) by 2nd, 3rd, compartment of 4th LM, and continuously the dorsal subcutaneous space and the subaponeurotic space. The anterior borderline of the TS was the 1st digital flexor tendon and the 1st LM; the posterior borderline was the fascia of abductor pollicis; the medial borderline was the palmar intermediate septum (PIMS); the lateral borderline was the tenden sheath of flexor pollicis longus and the lateral intermuscular septum of palm. The distal of this space opened to 1st WS by compartment of the 1st LM, and continuously to the dorsal subcutaneous space and the subaponeurotic space; the proximal of the TS was close.CONCLUSION: The proximal of the thenar space is close, the distal section of the metacarpal fascial spaces is separated into three little spaces, and the computerized three-D renconstruction of the fascial spaces of hand can provide some guidance for imaging diagnosis and surgical treatments.