踝关节外侧副韧带的解剖研究及对重建手术的意义

Study on lateral collateral ligament of ankle joint and its significance for reconstruction

目的对人体踝关节外侧副韧带的定量解剖及与周围骨性标志的解剖学测量,为踝关节外侧副韧带的重建手术提供理论参考。方法选取30具经福尔马林处理好的正常成人踝关节标本,对外侧副韧带进行精细解剖并对其起止点至周围骨性标志的距离进行定量测量,对其测量结果进行统计学分析。结果本实验30具踝关节标本中,前距腓韧带(ATFL)大致呈两端较宽,中部较窄的扁平四边体。其中18具ATFL(60%)分成双束,其上下两束的走行大致相同,而另12具则为单束(40%)。跟腓韧带(CFL)自外踝尖向后下斜行,止于跟骨外侧面,形状前宽后窄。经测量,ATFL腓骨起点距离腓骨前部结节(17.1±1.78)mm;距离腓骨隐匿结节(5.0±1.46)mm;距离腓骨尖(14.0±1.63)mm。ATFL距骨止点距离距骨胫距关节面(11.4±1.28)mm;距离距下关节面(18.0±2.07)mm;距离距骨前外软骨面(4.7±0.76)mm。CFL腓骨起点距离ATFL腓骨起点(6.1±2.04)mm。CFL跟骨止点距离跟骨外侧结节(15.0±2.48)mm;距离跟骨后上缘(14.1±1.44)mm;距离距下关节面(15.1±2.67)mm。计算变异系数(CV)结果:ATFL腓骨起点至腓骨前部结节距离CV(10.41%)<ATFL至腓骨尖距离CV(11.64%)<ATFL至腓骨隐匿结节距离CV(29.20%)。CFL跟骨止点至跟骨后上缘距离CV(10.21%)<CFL至跟骨外侧结节距离CV(16.53%)<CFL至距下关节面距离CV(17.68%)。结论踝关节外侧副韧带与周围骨性标志的距离有一定的变异性,认为变异度可能反映外侧副韧带与周围骨性标志的稳定性。比较CV得出ATFL腓骨起点至腓骨前部结节和ATFL至腓骨尖均是稳定性较好的骨性标志;而CFL至其各骨性标志的CV相差不大,但是考虑到距下关节面在关节镜下更加容易被观察到,因此在实际操作中,关节镜下重建CFL时将距下关节面作为定位的标志具有更好的可行性。为踝关节外侧副韧带重建手术提供了一定的数据和理论支持。

Objective To provide a theoretical reference for the reconstruction of lateral collateral ligament of ankle joint.Methods 30 normal adult ankle joint specimens treated with formalin were selected.The lateral collateral ligament was dissected carefully,and the distance from its starting point to the surrounding bone markers was measured quantitatively,and the measurement results were statistically analyzed.Results The anterior talofibral ligament(ATFL)was a flat quadrilateral with wide ends and narrow middle.Among them,18 ATFL(60%)were divided into two bundles,and the upper and lower bundles were almost the same,while the other 12 were single bundle(40%).The calcaneofibular ligament(CFL)was oblique from the tip of the lateral malleolus to the lateral surface of the calcaneus.According to the measurement,the distance from the origin of the fibula of ATFL to the anterior fibular tubercle was(17.1±1.78)mm,the distance from the occult tubercle of the fibula was(5.0±1.46)mm,and the distance from the tip of the fibula was(14.0±1.63)mm.The distance between the insertion point of ATFL talus and the articular surface of tibial talus was(11.4±1.28)mm,(18.0±2.07)mm and(4.7±0.76)mm,respectively.The distance between CFL and ATFL was(6.1±2.04)mm.The distance between CFL calcaneal insertion point and lateral calcaneal tubercle:(15.0±2.48)mm;distance from posterior superior edge of calcaneus:(14.1±1.44)mm;distance from inferior articular surface:(15.1±2.67)mm.The coefficient of variation(CV)was calculated.The distance from the origin of the fibula to the anterior fibular tubercle of ATFL(10.41%)<the distance from ATFL to the tip of fibula(11.64%)<the distance from ATFL to the occult nodule of fibula(29.20%).The distance between CFL calcaneal insertion point and the posterior superior edge of calcaneus(10.21%)<CFL to lateral calcaneal tubercle CV(16.53%)<CFL to subtalar articular surface CV(17.68%).Conclusion The distance between lateral collateral ligament of ankle joint and surrounding bone markers has certain variability,which may reflect the stability of lateral collateral ligament and surrounding bone markers.Comparing the CV,it is concluded that ATFL from the origin of fibula to the anterior fibular tubercle and from ATFL to the tip of fibula are bone markers with good stability;however,the CV from CFL to its bone markers is not significantly different,but considering that subtalar articular surface is more easily observed under arthroscopy,it is more feasible to use subtalar articular surface as a localization marker in the reconstruction of CFL under arthroscopy.It provides some data and theoretical support for the reconstruction of lateral collateral ligament of ankle joint.