胫骨高位截骨术后拇长伸肌麻痹的解剖学研究

Anatomy Study on Palsy of the Extensor Hallux Longus Muscle after Proximal Tibial Osteotomy

目的 探讨胫骨高位截骨术后拇长伸肌麻痹的解剖学因素。方法 在２５ 具（５０ 侧）尸体的下肢上，对腓深神经的起点、拇长伸肌的形态及其肌支的数目、入肌方式、发出点及入肌点的距离等进行了观察。结果 腓深神经起始部距腓骨小头最隆起点的距离为［２０．９ ±３．５（６．９～３７．５）］ ｍｍ 。拇长伸肌的肌支以４ 种类型入肌：Ｉ型，从腹侧入肌（１１ 例，占２２％） ；ＩＩ型，从胫侧入肌（２９ 例，占５８％ ）；ＩＩＩ型，从腓侧入肌（６ 例，占１２％） ；ＩＶ型，从胫腓两侧入肌（４ 例，占８％ ）。拇长伸肌由单根肌支支配的占４０％ ，其肌支发出点距腓骨小头的距离平均为７１ ｍｍ ，８１ ．１％ 的起始点位于４０ ～１０９ ｍｍ 间；发出点与入肌点的距离平均为２６ ｍｍ ，其中８７．７％ 在１０～５９ ｍｍ 间。结论 拇长伸肌的神经支配特点是胫骨高位截骨术后拇长伸肌麻痹重要因素，了解并在相对安全区操作。

Objective To investigate the anatomy factor of palsy of the extensor hallux longus muscle after proximal tibial osteotomy. Methods In 50 specimens from cadavers, we dissected the extensor hallux longus muscle, and payed special attention to the motor branches. Results The distance between points of origin of deep peroneal nerve from the truncus and points of fibular head was 20.9±3.5(6.9～37.5)mm, and four types of the nerve entry into the muscle were found. Motor nerves of 11 cases entered the muscle from the ventral aspect,29 from the tibial side, 6 from the fibular sides, and 4 from the tibial and fibular sides. The average distance of origin of the motor from the truncus to the fibular head was 71 mm,and 81.1% points of origins were between 40 mm to 109 mm. The distances of points of the origin to the points of entry into the muscle averaged 26 mm and 87.7% of them were between 10 mm to 59 mm. Conclusions The anatomy characteristic of motor nerve supplying the exhalluces longus muscle is the important factor of the palsy of extensor hallux longus muscle after proximal tibial osteotomy.