封闭治疗跟腱炎的解剖学基础

Anatomical Basis of Treating the Achilles Tendinitis Using Local Steroid Injection

目的:为封闭治疗跟腱炎提供解剖学依据。方法:解剖30侧10%甲醛固定的下肢标本,观察和测量跟腱外周的筋膜鞘及神经血管、跟骨后滑囊、跟下滑囊和跟腱的形态结构等。结果:1.小腿后骨筋膜鞘浅层的纤维鞘与跟腱之间有一个潜在的腔隙;2.跟腱的前面、两侧面和上下两端都分布有营养跟腱的血管,而其后面没有分布;3.跟骨后滑囊位于跟骨结节软骨面与跟腱之间,跟下滑囊位于跟骨结节下部与足底脂肪垫之间;4.跟腱由小腿三头肌的肌腱组成,其胶原纤维束呈不同程度旋转。结论:封闭治疗跟腱炎时,应将药液注入跟腱周围潜在的筋膜鞘腔隙、跟骨后滑囊或跟下滑囊。

Objective To provide an anatomical basis for the treatment of achilles tendinitis using the local steroid injection.Methods Thirty formalin fixed lower limb specimens were dissected.The anatomic structures of their fascial sheaths surrounding the Achilles tendon,neurovascular structure,retrocalcaneal bursa and subcalcaneal bursa were observed and measured.Results There was a potential lacuna between the Achilles tendon and the fascial sheath.The nutrient vessels of Achilles tendon were distributed at its anterior and two lateral surface and both ends,but not in the posterior surface.The retrocalcaneal bursa was located betweenthe Achilles tendon and the superior facet of the calcaneal tuberosity,while the subcalcaneal bursa was located between heel fat pads and the inferior facet of the calcaneal tuberosity.The Achilles tendon fascicles originated from the triceps surae,which twisted among themselves.Conclusion During treating achilles tendinitis using the local steroid injection,medicinal liquidshould beinjected into the potential lacuna,retrocalcaneal bursa and subcalcaneal bursa.