第二趾跖板的应用解剖研究

发布时间：2018-01-28 17:19

本文关键词： 跖板跖趾关节足趾移植解剖　出处：《青岛大学》2007年硕士论文　论文类型：学位论文

【摘要】： 目的：通过对人体第二跖趾关节在跖板前移前、后活动范围的测定，研究了解跖趾关节过伸畸形的原因及与跖板的关系，采用跖板前移消除跖趾关节过伸畸形，并观测跖板前移的距离及张力与组织学改变，为临床提供理论依据。方法：1．冷冻截肢足标本21只，解剖第二趾系列。观测从足部分离前、后跖趾关节的活动范围，测量跖板的长度、宽度和厚度，测量跖板前移消除跖趾关节过伸畸形后跖趾关节的活动范围及跖板的张力与前移的距离，观察跖板前移前、后在相同负荷(2N)下跖趾关节背伸角度的变化。 2．成年健康鸡10只，取术足第二趾将跖板前移固定，石膏外固定6周，术后第10周取双足第二趾跖板，进行组织学观察，了解跖板前移固定后其组织学改变。结果：1．从足部分离前第二跖趾关节的被动活动范围是背伸62.75±4.74~0，屈曲38.61±2.45~0分离后跖趾关节的背伸角度增加15.88±4.51~0，达78.63±4.49~0，屈曲角度增加3.28±3.80~0，达41.89±3.59~0，与分离前比较差异均有统计学意义(P＜0.05)。第二趾跖板长度为19.16±1.63mm，宽度为7.73±0.73mm～11.59±0.93mm，厚度为1.88±0.27mm～4.71±0.28mm。 2．跖板前移后跖趾关节的背伸角度减少62.28±3.620，达16.35±2.650，与前移前比较差异有统计学意义(P＜0.01)，屈曲角度为41.33±2.61~0，与前移前比较差异无统计学意义(P＞0.05)。 3．跖趾关节屈曲200时跖板张力为217.5±18.3g，跖板前移距离为3.53±0.40mm；跖板前移固定于骨膜前、后在趾端施加2N力时，跖趾关节的背伸角度分别为54.15±3.500和5.61±1.13~0，背伸角度减小48.55±3.70~0，二者比较差异有统计学意义(P＜0.05)。 4．镜下可见胶原纤维沿跖板纵轴走形，间隔一定距离有斜形散射，可见分散存在的成纤维细胞，术后十周胶原纤维与成纤维细胞排列均正常，未见炎性细胞，证明跖板前移固定后没有明显的组织学改变。结论：第二二跖趾关节有过伸畸形的解剖特点，采用跖板前移可消除跖趾关节过伸畸形。前移后跖趾关节的被动活动范围是背伸16.35±2.65~0，屈曲41.3±2.61~0，当维持跖趾关节屈曲20~0时，，跖板前移距离为3.53±0.40mm，跖板张力为217.5±18.3g，跖板前移后其组织学无明显改变。
[Abstract]:Objective: to study the cause of metatarsophalangeal joint hyperextension and its relationship with metatarsophalangeal joint by measuring the range of movement of the second metatarsophalangeal joint before and after the metatarsophalangeal joint movement. The distance, tension and histological changes of plantar plate were observed to provide theoretical basis for clinical application. Methods 1.Twenty one frozen amputee specimens were dissected into the second toe series. The range of motion of the posterior metatarsophalangeal joint was observed and the length, width and thickness of the plantar plantar plate were measured before separation from the foot. The moving range of metatarsophalangeal joint and the distance between the tension of metatarsal plate and the forward movement of metatarsophalangeal joint were measured to observe the anterior movement of metatarsophalangeal joint. The change of dorsal extension angle of the lower metatarsophalangeal joint at the same load (2 N). 2. The second toe of the second foot was removed and the plantar plate was fixed with plaster for 6 weeks, and the plantar plate of the second toe of the second foot was taken 10 weeks after operation for histological observation. To understand the histological changes of plantar plate after anterior fixation. Results 1. The range of passive movement of the second metatarsophalangeal joint before separation from the foot was 62.75 卤4.74. The dorsal extension angle of the metatarsophalangeal joint was increased by 15.88 卤4.51% (78.63 卤4.490) after the flexion of 38.61 卤2.45 0. The flexion angle increased by 3.28 卤3.80 to 41.89 卤3.59kW. The difference was statistically significant (P < 0.05) and the length of the second toe plantar was 19.16 卤1.63 mm. The width was 7.73 卤0.73 mm and the thickness was 1.88 卤0.27 mm and 4.71 卤0.28 mm respectively. 2. The dorsal extension angle of metatarsophalangeal joint decreased by 62.28 卤3.620 to 16.35 卤2.650 after the anterior plantar plate movement, and there was significant difference between the two groups (P < 0.01). The flexion angle was 41.33 卤2.61g, and there was no significant difference between the two groups (P > 0.05). 3. The tension of plantar plate was 217.5 卤18.3g and the distance of plantar plate forward was 3.53 卤0.40mm when flexion of metatarsophalangeal joint was 200; The dorsal extension angle of metatarsophalangeal joint was 54.15 卤3.500 and 5.61 卤1.13, respectively. The back extension angle decreased by 48.55 卤3.70g, and the difference was statistically significant (P < 0.05). 4. Under the microscope, collagen fibers were found to be conformal along the longitudinal axis of plantar plate, with oblique scattering at a certain distance between them, and scattered fibroblasts were observed. The arrangement of collagen fibers and fibroblasts was normal 10 weeks after operation. No inflammatory cells were found, which showed that there were no obvious histological changes after anterior fixation of plantar plate. Conclusion: 22th metatarsophalangeal joint has the anatomical characteristics of hyperextension deformity, and the deformity of metatarsophalangeal joint can be eliminated by using plantar plate forward movement, and the passive activity range of metatarsophalangeal joint is 16.35 卤2.65%. When the flexion of metatarsophalangeal joint was maintained from 20 to 0:00, the forward distance of plantar plate was 3.53 卤0.40 mm, and the tension of plantar plate was 217.5 卤18.3g. There was no obvious change in histology after the plantar plate was moved forward.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

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