吻合血管的胫腓关节移植重建肘关节功能的解剖学基础

Anatomical basis of reconstructed elbow joint by vascularized tibiofibular joint graft

目的 :为吻合血管的胫腓关节移植修复肘关节缺损并重建肘关节屈伸功能的新术式提供解剖学依据。方法 :成年尸体 10具 2 0个下肢标本、5个上肢标本 ,观测胫腓关节的解剖学特点及切开部分胫腓前、后韧带后胫腓关节的张合范围 ,模拟上胫腓关节移植修复肘关节缺损、重建肘关节部分屈伸功能的手术。结果 :胫腓关节腓骨侧关节面呈梨形凹状 ,面积 (199.70± 43 .3 )mm2 ;胫骨侧关节面呈卵圆形凸状 ,面积 (13 7.2± 45 .4)mm2 ,胫骨侧关节面上缘有一关节唇样增厚。自下而上切开胫腓关节约 3 /4的胫腓前、后韧带 ,使该关节有约 75°的张合范围。胫腓关节移植可重建肘关节的 60°～ 75°屈伸范围 ,可用部分股二头肌腱及腓骨肌腱膜加强重建关节的后方与侧方稳定性。结论 :胫腓关节为微鞍状关节 ,胫腓关节移植修复肘关节缺损并重建肘关节的部分屈伸功能具有可行性 ,临床应用 1例 。

Objective:To provide anatomical basis for reconstructing the elbow joint by vascularized tibiofibular joint graft.Methods:The anatomical features of tibiofiular joint were observed on 20 sides of 10 adult cadaveric specimens.The open close ranges of tibiofibular joint were measured after the anterior and posterior tibiofibular ligaments were resected partially.The tibiofibular joint transplantation was imitated to repair the elbow defect and reconstruct the elbow function partially on 5 upper limb specimens.Results:The fibular side of tibiofibular joint facet presented concave pear shape and its area was 199.70±43.3mm 2.The tibial side presented convex and egg shape and its area was 137.2± 45.4 mm 2,and there is labium like thickening on upper margin of tibial articular facet.Three fourth of both anterior and posterior tibiofibular ligaments were resected so as to gain about 75° open close ranges in tibiofibular joint.There was 60°～75° flexion extension in the reconstructed elbow joint after tibiofibular joint graft.A portion of the biceps femoris tendon and aponeurosis of peroneus can be used to strengthen lateral and posterior stability of the reconstructed joint.Conclusion:Tibiofibular joint is a small sellar joint.It is feasible to be used to repair the elbow defect and reconstruct partially flexion extension function of the elbow joint by the tibiofilular joint graft.Clinical application in one case has been performed successfully.