踝关节距腓前韧带和跟腓韧带的解剖学特点

Anatomical Characteristics of the Anterior Talofibular and Calcaneofibular Ligaments in Ankle Joints

目的:观察踝关节不同体位下距腓前韧带(anterior talofibular ligament,ATFL)和跟腓韧带(calcaneofibular ligament,CFL)的形态学变化,并测量其基本参数、止点面积及韧带间的角度,为临床外踝韧带损伤的诊断和治疗提供参考。方法:选取47例国人踝关节标本,解剖外踝结构直至显露出外踝韧带,观察并记录ATFL和CFL的形态及分束。测量不同分束在踝关节中立位、背伸位、跖屈位及跖屈内翻位时的韧带长度和宽度,以及中立位下ATFL和CFL之间的夹角。将韧带从止点离断、标记并用Image J软件计算附着区域面积。结果:共有13例(27.6%)标本的ATFL呈单束结构,31例(66%)标本的ATFL由双束构成,余下3例(6.4%)由三束构成。中立位时单束ATFL平均长18.91±2.95 mm(与双束ATFL中的上束长度19.4±2.53 mm接近)、宽6.70±1.37 mm;其余分束结构的长、宽均小于单束的测量数值。CFL的长、宽分别为26.73±3.49 mm和4.95±0.97 mm。ATFL和CFL在中立位的角度约113°。各韧带的形态、位置及参数随踝关节体位的改变而发生变化。CFL在跟骨上的止点面积最大(1.40±0.38cm^(2)),大于其在腓骨端的面积(0.53±0.18 cm^(2))以及ATFL在腓骨(≤0.62±0.18 cm^(2))或距骨端(≤0.53±0.16 cm^(2))的面积。结论:踝关节ATFL的形态存在着一定变异,ATFL和CFL在不同体位下会发生形态和参数的改变,各束韧带的功能可能存在差异。这有助于了解正常踝关节的结构和功能,并推测韧带损伤的机理。韧带之间的角度及止点面积可能为解剖修复外踝韧带提供一定参考。

Objective To observe the morphological features of the anterior talofibular ligament(ATFL)and the calcaneofibular ligament(CFL)of ankle joint in different positions,and to measure the basic parameters,the area of footprints and the angle between ATFL and CFL,so as to provide references for the diagnosis and treatment of lateral ankle ligament injuries.Methods Forty-seven Chinese ankle specimens were dissected to expose the lateral ankle ligaments,and to observe and record the morphological features and number of bands.The length and width of the ATFL and CFL at neutral,dorsiflexion and plantarflexion(or combined with inversion)positions,as well as the angle between ATFL and CFL at neutral position were measured.The ligaments were dissected near the insertions,and the areas of footprints were calculated using Image J software.Results A total of 13(27.6%)specimens had a single-band ATFL structure,31(66%)specimens had a double-band ATFL,and the remaining3(6.4%)had three bands.The average length of single-band ATFL at the neutral position was 18.91±2.95 mm(close to the length of the upper band in double form:19.4±2.53 mm)and the width was 6.70±1.37 mm.The lengths and widths of bands in double-or three-band form ATFL were all shorter than of the single band.The average length and width of CFL were 26.73±3.49 mm and4.95±0.97 mm,respectively.The average angle between the ATFL and CFL at the neutral position was approximately 113°.Besides,the morphology,position and parameters of each band changed with the position of the ankle joint.Moreover,The CFL had the largest footprint on the calcaneus(1.40±0.38 cm^(2)),greater than the area at its fibular insertion(0.53±0.18 cm^(2))and the footprint of the ATFL on the fibula(0.62±0.18 cm^(2))or on the talus(0.53±0.16 cm^(2)).Conclusion The morphology of ATFL in the ankle joint has certain variation.The morphologies and parameters of the ATFL and CFL vary with the position of the ankle joint,which may help to understand the function of ligaments and speculate the mechanism of injury.Besides,the angle between the ligaments and the area of the footprint may provide some references for the anatomical repair of lateral ankle ligaments.