跖腱膜起点的解剖及超声影像学研究

Observations of the origin and insertion of the plantar aponeurosis based on anatomic and sonographic analysis

目的研究跖腱膜起点的确切部位及其与跟骨骨刺的关系。方法对14只足标本行解剖观察、X线摄片，3只胎儿足行组织学切片，20例成人正常足和52例跖腱膜炎足行超声观察。结果①足标本解剖观察：跖腱膜位于跟骨结节内侧突的跖侧，但与其不相联系，向后附着于跟骨结节跖面，其附着处不是一个点而是一个面。再向后与后方跟腱来源的腱性组织在跟骨结节后下方相互移行融合，包被整个跟骨结节跖后面并紧密地附着于其上。②胎儿足跟部组织学观察：跖腱膜和跟腱呈强嗜酸性带状物，两者在跟骨结节的跖侧和后侧相连续（移行），无明显分界，并紧密地附着于跟骨上。③超声观察：正常跖腱膜呈厚度一致、均质的薄层带状强回声，其起始部附着于整个跟骨结节跖侧，并与后方跟腱来源的腱膜相连续，两者无明显分界。跖腱膜炎时，整个跟骨结节跖侧均可见增厚的跖腱膜。跟骨骨刺并不发生于跖腱膜内。结论跖腱膜起始于整个跟骨结节跖侧面。跟骨骨刺发生于足内在肌如趾短屈肌起点处，不在跖腱膜内。

Objective To identify the exact origin and insertion of plantar aponeurosis and the anatomic relationship of calcaneal spur to plantar aponeurosis. Methods Fourteen specimen of feet were dissected and radiographed. Three fetus feet were observed histologically. Sonographic evaluation was carried out on 20 normal adults and 52 patients with plantar fasciitis. Results （1） Anatomic observation found that plantar aponeurosis was located under the medial process of calcaneus but not attached to it,and proximally attached to the plantar aspect of calcaneal tuborosity. The insertion （origin） of plantar aponeurosis was not a point but a face. Posteriorly the plantar aponeurosis and fascia of Archlles heel were fused or transmigrated together,entirely covered and attached very coherently to the plantar and posterior aspect of calcaneal tuborosity. （2） Histological observation of heel of fetuses found plantar aponeurosis and fascia of Archlles heel were eosinophil band-like structure. Both continued at the plantar and posterior aspect of calcaneus and attached closely to bone at this area. There were no significant demarcation between them. （3） Sonographic evaluation：normal plantar aponeurosis showed a thin band-like echo, its orgin attached to entire plantar aspect of calcaneal tuberosity and continued with fascia coming posteriorly from Archlles heel. No distinct boundary existed between these two fascias. When plantar fasciitis occurred,the orgin of plantar aponeurosis thickened significantly, this phenomenon could be detected in wholly plantar aspect of calcaneal tuberrosity. The heel spur didn＇t located within plantar aponeurosis. Conclusions Plantar aponeurosis orginates from entire plantar aspect of cancaneal tuberosity. Heel spur occures in the orgin of the intrinsic musculature, such as flexor digitorum brevis,and doesn＇t locate within plantar aponeurosis.