第4、5跖跗关节的应用解剖及临床意义

Applied anatomy and clinical significance of the fourth and fifth tarsometatarsal joints

目的通过测量第4、5跖跗关节的多个解剖学参数,了解具体结构,评估其活动能力。方法对10个成人新鲜冰冻足部标本进行解剖测量第4、5跖跗关节的关节面直径、关节面夹角和第5跖骨倾斜角。结果①测得第4跖跗关节面远侧横径为(8.58±0.30)mm,纵径(12.89±0.52)mm,近侧横径为(8.65±0.29)mm,纵径(13.0±0.47)mm;第5跖跗关节面远侧横径(10.61±0.98)mm,纵径(12.22±0.46)mm,近侧横径(8.65±0.29)mm,纵径(13.0±0.47)mm;②第5跖骨倾斜角为51.5°±2.8°,骰骨两跖跗关节面所构成的夹角为147.2°±8.5°;③两关节为平面关节,第5跖跗关节面呈三角形,第4跖跗关节面呈长方形,纵轴较长。结论第4、5跖跗关节为平面关节,在不同平面尤其矢状面具有一定的活动度,临床上需要尽可能保留此两关节的活动功能。

Objective To study the structure of the fourth and fifth tarsometatarsal joints and to evaluate the motion ability by measuring their anatomic parameters. Methods Ten fresh-frozen cadaver foot specimens were used to measure the transverse and longitudinal diameters of the fourth and fifth tarsometatarsal joints, including angle of the two joints, and the tilt angle of the proximal fifth metatarsal joint. Results （1）The average transverse diameter of distal fourth metatarsal articular surface was （ 8.58 ± 0.30 ） mm, longitudinal diameter （ 12.89 ±0.52 ） mm while the proximal fourth metatarsal articular surface was （ 8.65 ± 0.29 ） mm, longitudinal diameter （ 13.0±0.47 ） mm. The average transverse diameter of distal fifth metatarsal articular surface was （10. 61± 0. 98）mm, longitudinal diameter （12.22±0.46） mm while the proximal fifth metatarsal articular surface was （8.65 ± 0.29 ） mm, longitudinal diameter was （ 13.0 ±0.47 ） mm. （2）The average tilt angle of fifth metatarsal articular surface was （51. 5° ± 2. 8°） while the articular angle of tarsometatarsal joints on cuboid （ 147.2°±8.5°）. （3）Both the fourth and fifth tarsometatarsal joints were flat joints, hence the longitudinal axis was longer. The fifth tarsometatarsal joint was triangle while the fourth one was rectangle. Conclusion Since the fourth and fifth tarsometatarsal joints are flat joints, there bear have relatively large action scope in different plane especially in sagittal plane. The action scope of these two joints should be preserved as much as possible in clinical practice.