踝管的应用解剖

Clinical anatomy of tarsal tunnel

目的为阐明踝管综合症的发病原因,寻找最佳的治疗方法,提供解剖学基础资料。方法局部解剖成人踝部及足底16侧,观测有关踝管的构成;屈肌支持带(分裂韧带)的长度、宽度、厚度及其发出的纤维隔。结果踝管由屈肌支持带、内踝、距骨、跟骨、三角韧带和跟腱围成;屈肌支持带由足部深筋膜在内踝后下方增厚形成,从内踝向后下附着于从跟骨结节内侧突到跟骨后面上缘之间的跟骨内面,其长为(47.21±0.26)mm、中间部宽为(31.41±0.32)mm、厚度为(1.08±0.17)mm;屈肌支持带从踝管发出2片纤维隔,分别形成胫骨后肌腱和趾长屈肌腱的腱纤维鞘。结论有关踝管的构成与一般教课书上所描述的少有差异;屈肌支持带的厚度与踝管内压有一定关系;任何引起增加踝管内压力的因素都可直接或间接地引起踝管综合症的发生,治疗踝管综合症的最佳方法是手术切断屈肌支持带,显微外科手术松懈胫神经的神经束膜。

Objective To find the etiology and the best treatment of tarsal tunnel syndrome, and provide more basic information for anatomy. Methods Conduct local anatomy of adult ankle and plantar 16 side, observe the structure of Tarsal Tunnel,including the length, width, thickness and linking Fibrous Septa of Flexor Support Band（Split Ligament）. Results Tarsal tunnel was surrounded by flexor support band, malleolus, talus, calcaneus, triangular ligament and achilles tendon. Flexor support band,attached to the inner ridge of calcaneal tubercle on one end and on the other end, to the inner surface of the calcaneus between the rear edge of the calcaneus, was formed by thickened foot deep fascia after the bottom of the medial malleolus. The length of flexor support band was（47.21±0.26） mm, the width of the middle part of it was（31.41±0.32） mm and the thickness was（1.08±0.17） mm. At the position of the Tarsal Tunnel, two pieces of fibrous septa extended from the flexor support band, respectively forming posterior tibial tendon and tendon sheath fiber of digitorum longus tendon. Conclusion There is almost no difference between the structure of Tarsal Tunnel and the one described in the textbook. The thickness of Flexor Support Band is related with the inside pressure of Tarsal Tunnel. Any factors increasing the inside pressure of Tarsal Tunnel can directly or indirectly cause the happening of Tarsal Tunnel Syndrome. And the best treatment to it is to cut Flexor Support Band by operation or relax tibial nerve perineurium through microsurgery.