跖跗关节骨性结构的解剖及临床意义

Applied anatomy and clinical significance of tarsometatarsal joint

目的通过对跖跗关节骨性结构的观察、测量，探讨跖跗关节骨性结构稳定的解剖学基础，及其活动度的临床意义。并为临床跖跗关节损伤的治疗提供理论依据。方法对12个成人足标本进行解剖、测量。测量第1—5跖跗关节面横径、纵径及深度；分别测量榫孔内、外侧缘的深度。结果（1）榫卯样结构内侧径（10．02±1．22）mm，外侧径（9．92±1．17）mm；（2）跖跗关节面的关节面深度：第1跖骨（0．98±0．15）mm，第2跖骨（0．02±0．02）mm，第3跖骨（0．01±0．01）mm，第4跖骨（1．32±0．15）mm，第5跖骨（1．46±0．17）mm；（3）跖跗关节远侧端关节面横径、纵径：第1跖骨关节面横径（17．25±1．01）mm，纵径（28．64±1．75）mm；第2跖骨关节面横径（15．24±1．13）mm，纵径（20．46±2．31）mm；第3跖骨关节面横径（13．30＋2．27）inln，纵径（19．12v1．57）mm；第4跖骨关节面横径（11．80±1．23）mm，纵径（17．17＋1．84）mm；第5跖骨关节面横径（18．66±2．80）mm，纵径（is．80±2．66）mm；（4）跖跗关节近侧端关节面横径、纵径：内侧楔骨关节面横径（15．9±1．52）mm，纵径（26．02±3．23）mm；中间楔骨关节面横径（13．07±1．25）mm，纵径（21．09±1．12）mm；外侧楔骨关节面横径（14．18±1．45）mm，纵径（20．15±1．95）mm；骰骨关节面横径（24．95±2．83）mm，纵径f17．72±1．37）mm。结论（1）跖跗关节的榫卯样结构，尤其是榫孔内、外侧缘的深度，是跖跗关节稳定的关键因素：（2）跖跗关节的关节面深度很浅，接近于平面关节，仅第4，5跖跗关节在矢状面和水平面有一定的活动度．手术治疗一期尽可能保留此关节。

Objective To explore the anatomical basis of stability by observing and measuring the bony structures of the tarsometatarsal joint, and to explore the clinical significance of its activity, and to find more effective treatment of the tarsometatarsal joints injury.Methods Twelve cadaver foot specimens were used to dissect and measure. We measured the surface diameter,longitudinal diameter of the first to the fifth tarsometatarsal joints, and the depth of the articular surface; We measured the medial and lateral depth of the mortise.Results （1）The inside diameter of the mortise（10.02 ± 1.22）mm, outer diameter （9.92±1.17）mm; （2） The depth of the articular surface： first metatarsal （0.98±0.15）mm, second metatarsal （0.02 ±0.02）ram, third metatarsal （0.01 ±0.01）nun, fourth metatarsal （1.32±0.15）rnm , fifth metatarsal （1.46±0.17）mm; （3）The transverse diameter of first metatarsal articular surface （17.25±1.01）mm, longitudinal diameter （28. 64±1.75） mm; the transverse diameter of second metatarsal articular surface （15.24±1.13）mm, longitudinal diameter （20.46±2.31）mm; the transverse diameter of third metatarsal articular surface （13.30±2.27）mm, longitudinal diameter （19.12-4-1.57）mm; the transverse diameter of fourth metatarsal articular surface （11.80 4-1.23）ram, longitudinal diameter （17.17±1.84）mm; the transverse diameter of fifth metatarsal articular surface （18.66± 2.80） mm, longitudinal diameter （15.80±2. 66）ram; （4）The transverse diameter of medial cuneiform bone metatarsal articular surface （15.9±1.52）mm, longitudinal diameter （26.02±3.23）mm; the transverse diameter of intermediate cuneiform bone articular surface （13.0±1.25）mm, longitudinal diameter（21.09±1.12）mm; thetransverse diameter of lateral cuneiform bone articular surface （14.18 ±1.45）mm, longitudinal diameter （20.15 ± 1.95）mm; the transverse diameter of cuboid bone