踝关节韧带解剖学观测

Anatomical observation of ligaments of ankle joint

目的探讨踝关节各韧带的形态学基础,分析踝关节易运动损伤的解剖学原因,并为临床诊断和治疗提供基础数据。方法成人尸体下肢37例,将踝关节内外侧韧带完整、准确、清晰地暴露,观察韧带走行、分支及起止点。采用具有良好韧性的细金属丝,沿韧带的走行方向紧贴于韧带的表面,在细金属丝上于韧带起止点处做标记,用分规卡于2标记点。用游标卡尺(精确度为0.02 mm)测量内外侧韧带的长度和最宽处宽度。结果37例标本中14例距腓前韧带与教科书中描述有异。变异的距腓前韧带呈双条状分布,1条起于外踝前缘,向前内侧走行,止于距骨颈;另1条起自外踝前缘稍下,向前内侧走行,止于距骨颈外侧面紧靠距骨外踝关节面前下方,位于上1条韧带的下方。三角韧带、距腓前韧带、距腓后韧带和跟腓韧带平均长度分别为(34.34±3.36)mm、(30.82±5.20)mm、(31.02±3.85)mm和(31.22±3.69)mm;最宽处平均宽度分别为(28.90±4.53)mm、(9.18±3.90)mm、(8.59±2.77)mm和(5.29±1.64)mm。变异的距腓前韧带上方韧带平均长度为(28.71±3.23)mm;最宽处平均宽度为(6.63±0.95)mm;其下方韧带平均长度为(18.03±2.94)mm;最宽处平均宽度为(4.78±1.46)mm。结论距腓前韧带是踝关节运动损伤中最易损伤的韧带,应加以重视和保护。变异的距腓前韧带对踝关节具有一定的保护功能,为临床对踝关节韧带损伤的诊断提供断层解剖学依据。在对踝关节进行手术治疗时,应充分考虑其变异的可能性,慎重选择合适的手术入路和手术修补方案,避免发生意外的韧带损伤。

Objective To study the morphology foundation of ligaments of ankle joint and the reasons of anatomy about movement injury of ankle joint, and to provide the foundation data for clinical diagnosis and therapy. Methods Thirty-seven ankle joints of body limb were chosen. The ligaments of ankle joint were revealled completely, precisely and clearly. The coursers, branches and enthesis of these ligaments were observed, using flexible and slender wire to go along with the course of ligaments and marking the enthesis of ligaments on wire,then using sliding caliper （accuracy：0.02 mm ） to measure the length and width of exterior and interior ligaments of ankle joint. Results Fourteen cases of anterior talofibular ligament were different from that described in the textbook. Variable anterior talofibular ligament was of double strip distribution. One variable anterior talofibular ligament began from extmmalleolus, went anteromedially and ended at the neek of talus ; And the other variable anterior talofibular ligament loeated below it. The average length of deltoid ligament, anterior talofibular ligament, posterior talofibular ligament and ealcaneofibular ligament were （34.34 ± 3.36 ） mm, （ 30.82 ± 5.20） mm, （ 31.02 ± 3.85 ）mm and （ 31.22 ± 3.69 ） mm;And the average width were （28.90 ±4.53） mm, （9.18 ±3.90） mm, （8.59 ±2.77） mm and （5.29 ± 1.64） mm respectively. The average length of the above variable anterior talofibular ligament was （28.71 ±3.23 ） mm, and the average width was （6.63±0.95） mm;The average length of below was （18.03 ±2.94） mm,and the average width was （4.78 ±1.46） mm Conclusion Anterior talofibular ligament is easier to injury in ankle movement,and should be paid attention to and protected. The possibility of variation should be eonsidered fully, and appropriate surgical approach and operate repair plan should be chosen carefully during the treatment of ankle surgery in order to avoid accident of ligament damage.