内踝的应用解剖及临床意义的初步研究

发布时间：2018-06-26 06:40

本文选题：内踝 + 内踝角　；参考：《中南大学》2007年硕士论文

【摘要】： 目的对内踝进行解剖学测量，为临床手术方法和内固定的选择，术中安全而准确地置入内固定以及设计内踝定位导向器提供解剖学依据。方法选取中南大学湘雅医学院人体解剖教研室完整成人胫骨骨性标本共20对，男女各10对，，左右配对；选取中南大学湘雅三医院放射科标准内踝正侧位X片20例，男女各10例，左右配对，观察内踝的大体形态。选取七条线：1、胫骨前面观有五条线：①胫骨的中轴线L_1；②经胫骨下端关节面的切线L_2(平行胫距关节面)；③内踝外侧面的切线L_3；④内踝内侧面的切线L_4；⑤经内踝尖与胫距关节面的平行线L_5；2、胫骨内侧面观有两条线：⑥胫骨下端关节面水平内踝前后缘的连线L_6(即mn连线)；⑦经内踝下缘与胫距关节面的平行线L_7。选取三个点：①内踝尖o；②胫骨下端关节面水平内踝最前缘点m：③胫骨下端关节面水平内踝最后缘点n。通过选取以上的线和点获得以下的内踝参数：①MA(由线L_1和L_3相交形成的锐角，即内踝的内翻角，简称内踝角)；②TA(由线L_2和L_3相交形成的锐角，即胫骨角)；③内踝的上下径即高度H(线L_2和L_5之间内踝的实际长度即o点到线mn的垂直距离)；④内踝上端宽度W_上(即在胫骨下端关节面水平内踝前后缘之间的距离mn)；⑤内踝下端宽度W_下(线L_7在内踝前后缘之间的距离)；⑥内踝上端厚度T_上(内踝根部处的厚度)；⑦内踝下端厚度T_下(内踝尖基底部处的厚度)；⑧内踝中线厚度T(内踝一半高度处的厚度)。在骨性标本上完成对内踝高度H、内踝上端宽度W_上、内踝下端宽度W_下、内踝上端厚度T_上、内踝下端厚度T_下和内踝中线厚度T的测量，在X线片上完成对内踝角MA的测量。结果1．侧面观从上到下内踝逐渐变窄，近似于一个倒立的梯形。2．从上到下内踝的厚度逐渐均匀的变薄，但变化不大。3．通过在骨性标本上和在X线片上对内踝左右两侧参数分别进行测量比较差异无统计学意义(p＞0.05)。4．分别在男女骨性标本上对内踝高度H、内踝上端宽度W_上、内踝下端宽度W_下、内踝上端厚度T_上、内踝下端厚度T_下和内踝中线厚度T进行测量比较差异有统计学意义(p＜0.05)。5．分别对男女X线片上内踝角MA进行测量比较差异无统计学意义(p＞0.05)。6．通过在X线片上测量可以发现存在一相对恒定的内踝角，它有一个相对稳定的变化范围。结论1、本研究通过对内踝的解剖学研究，提出了内踝相关参数的测量方法，特别是提出了内踝角的概念。 2、获得内踝相关参数的可靠解剖学数据，为内踝骨折内固定的选择以及术中准确安全地置入内固定提供指导，并为下一步设计内踝骨折手术的定位导向器提供解剖学依据。
[Abstract]:Objective to measure the anatomy of medial malleolus and provide anatomic basis for the choice of clinical operation and internal fixation, the safe and accurate insertion of internal fixation and the design of medial malleolus positioning guide. Methods A total of 20 pairs of intact adult tibial bone specimens were selected from the Department of Human Anatomy, Xiangya Medical College, Central South University, 10 pairs of male and female pairs, and 20 cases of standard medial ankle lateral position X ray, 10 cases of male and female, in the Department of Radiology, Xiangya third Hospital of Central South University. Pairing left and right to observe the gross shape of the medial malleolus. Select seven lines: 1, 5 lines in front of tibia: 1 tibia central axis L1T 2 through the tibia distal articular surface tangent line L2 (parallel tibial talus articular surface) 3 medial malleolus lateral side tangent line L3M4 medial malleolus side tangent L4; (5) parallel line L5D through the medial malleolus and tibial talus articular surface, and two lines at the medial side of tibia: 1 / 6, L6 (mn line), L6 (mn line) through L7 parallel line between medial malleolus and tibial talus articular surface. Select three points: 1 at the tip of the medial malleolus and 2 at the level of the articular surface of the lower end of the tibia. The point of the anterior edge of the medial malleolus at the lower end of the tibia is m: 3. By selecting the above lines and points, the following parameters of the medial malleolus: 1MA (acute angle formed by the intersection of line L1 and LSP 3, I. E. the inner malleolus angle, abbreviated as the medial malleolar angle) were obtained, and the 2TA (acute angle formed by the intersection of line L2 and LSP 3, that is tibia angle) was obtained. (3) the upper and lower diameter of the medial malleolus is the height H (the actual length of the medial malleolus between L2 and LST5 is the vertical distance from o point to line mn) 4 the width of the upper end of the medial malleolus W _ above (that is, the distance between the anterior and posterior sides of the medial malleolus at the lower articular surface of the tibia). (5) the width of the lower end of the medial malleolus (the distance between the anterior and posterior margin of the medial malleolus) and the thickness of the upper end of the medial malleolus (the thickness of the root of the medial malleolus), and the thickness of the lower end of the medial malleolus (the thickness of the base of the medial malleolus); Medial malleolus thickness T (thickness at half the height of medial malleolus). The height of the medial malleolus (H), the width of the upper end of the medial malleolus (W _), the width of the lower end of the medial malleolus (W _), the thickness of the upper end of the medial malleolus (T _), the thickness of the lower end of the medial malleolus (T _) and the thickness of the median line of the medial malleolus (T _) were measured on the bone specimen. Results 1. The lateral view gradually narrowed from the top to the bottom of the medial malleolus, which was similar to a inverted trapezoidal shape. The thickness of the medial malleolus from the top to the bottom became thinner and more evenly. There was no significant difference in the parameters of the left and right sides of the medial malleolus between the bone specimens and the X-ray films (p > 0.05) .4.The height of the medial malleolus Hand the width of the upper end of the medial malleolus were measured on the male and female bone specimens respectively. The width of the lower end of the medial malleolus W _, the thickness of the upper end of the medial malleolus T _, There was significant difference in the thickness of the medial malleolus between the lower end of the medial malleolus and the middle line of the medial malleolus (p < 0.05). 5. There was no significant difference in the measurement of the medial malleolus angle between male and female X-ray films (p > 0.05) .6. On-chip measurements show a relatively constant angle of the medial ankle, It has a relatively stable range of changes. Conclusion 1. Based on the anatomical study of the medial malleolus, a method for measuring the parameters of the medial malleolus was put forward. In particular, the concept of medial malleolus angle was put forward. 2. The reliable anatomical data of medial malleolus related parameters were obtained, which provided guidance for the choice of internal fixation of medial malleolus fracture and the accurate and safe insertion of internal fixation during operation. It also provides anatomic basis for the design of positioning guide for medial malleolus fracture.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R687.1;R322

【参考文献】