踝关节外侧副韧带定量解剖研究

Anatomical Landmarks for Lateral Ankle Ligament Reconstruction—a Cadaveric Study

目的:通过对人体踝关节标本的定量解剖,明确踝关节外侧副韧带相关形态参数及其起止点足印区至各解剖标志的距离,为踝关节外侧副韧带重建手术提供解剖学依据。方法:共选取19例下肢尸体标本,对踝关节外侧副韧带进行精细解剖观察并对相关参数如长度、宽度、厚度及其起止点至各解剖标志的距离进行定量测量。结果:19例人体下肢标本中,前距腓韧带(ATFL)平均长度为23.1±2.98 mm,其中单束8例(42.1%),双束11例(57.9%)。前距腓韧带腓骨起点至腓骨前部结节平均距离(AA)为17.1±3.00 mm,至腓骨隐匿结节(AO)平均距离为5.1±1.69 mm,至腓骨尖(AT)平均距离为14.1±2.86mm,前距腓韧带距骨止点至距骨上下关节面的平均距离分别为11.4±2.25 mm及18.4±2.30 mm,至距骨前外软骨面的平均距离为4.8±1.42 mm。跟腓韧带(CFL)平均长度为31.4±3.55 mm,跟腓韧带腓骨起点至前距腓韧带腓骨起点的平均距离为6.4±2.55 mm,跟腓韧带与前距腓韧带间夹角为116.6±12.69°,跟腓韧带跟骨止点至跟骨外侧结节(CP)平均距离为15.4±2.86 mm,至跟骨后上缘(CC)平均距离为13.9±2.46 mm,至距下关节面(CS)平均距离为15.2±3.21 mm。以变异度衡量各解剖标志相对稳定性结果如下:ATFL腓骨止点AA(17.54%)<AT(20.28%)<AO(33.14%),CFL跟骨止点CC(17.70%)<CP(18.57%)<CS(21.1%)。结论:通过解剖研究发现踝关节外侧副韧带形态参数及起止点至各解剖骨性标志的距离存在一定的变异性,为临床上解剖重建踝关节外侧副韧带治疗慢性踝关节不稳定提供了解剖依据。

Purpose To clarify the morphological parameter and describe the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks through precisely anatomical exploreof human cadaveric ankles,so as to provide anatomical evidences for the reconstruction of lateral ankleligaments. Methods Nineteen ankle specimens were dissected to isolate the lateral ankle ligaments andmeasure the morphological parameters such as length,width,thickness and the distance from the insertion of the lateral ankle ligaments to the adjacent bony landmarks. Results The average length of anterior talofibular ligaments（ATFL）was 23.1 ± 2.98 mm,among which 8 were single-banded（42.1%）and11 were double-banded（57.9%）. The average distance from the fibular origination of ATFL to the anterior tubercle of fibula（AA）was 17.1 ± 3.00 mm,to the fibular obscure tubercle（AO）was 5.1 ± 1.69 mm,to the tip of the fibula（AT）was 14.1 ± 2.86 mm. The distances from the talus insertion of ATFLto the superior and inferior talus articular surface were 11.4 ± 2.25 mm and 18.4 ± 2.30 mm respectively,to the anterior lateral talus chondral surface was 4.8 ± 1.42 mm. The average length of calcaneofibular ligament（CFL）was 31.4 ± 3.55 mm. The average distance of the fibular origination from ATFLto CFL was 6.4 ± 2.55 mm. The average angle between ATFL and CFL was 116.6 ± 12.69°. The distance from the calcaneus insertion of CFL to the peroneal tubercle（CP）was 15.4 ± 2.86 mm,to the posterior superior border of calcaneus（CC）was 13.9 ± 2.46 mm,to the subtalar joint surface was 15.2 ±3.21 mm. The coefficient variation assessing the anatomical reliability of different bony landmarks wereas follows：ATFL fibular origination AA（17.54%）〈AT（20.28%）〈 AO（33.14%）,CFL calcaneus insertion CC（17.70%）〈CP（18.57%）〈CS（21.1%）. Conclusion Certain variations exist in the morphologicalparameters and the distances from the insertion of the lateral ankle ligaments to the adjacent bonylandmarks. It provides anatomical evidence for lateral ankle ligament reconstruction in treating chronic ankle instability.