距跟骨间韧带的解剖学特性及生物力学分析

发布时间：2018-07-05 04:16

本文选题：距下关节 + 韧带　；参考：《河北医科大学》2007年硕士论文

【摘要】： 目的:( 1 )观察正常距跟骨间韧带(interosseous talocalcaneal ligament,ITCL)前、后束的解剖学特点并分析其临床意义。(2)研究正常距跟骨间韧带前、后束的生物力学特性及其临床意义。材料和方法:(1)10%甲醛固定成年人正常尸体足标本20副,不分性别、侧别,对距跟骨间韧带前、后束的形态进行观察。将标本离断踝关节后,切断距下关节后外侧面的距跟外侧韧带以及内侧面的三角韧带胫跟部、距跟内侧韧带。经解剖制成距骨-韧带-跟骨标本,解剖分离跗骨窦部的结构,显露伸肌下支持带的三个根及距跟骨间韧带的外侧缘。沿跗骨管后缘走行方向锯开距骨,将其后部去除即可显露跗骨管后部结构。分离显露距跟骨间韧带后束,观察其形态,并用游标卡尺(0.02mm)进行大体测量。切除后束,分离并切断其前方的伸肌下支持带内侧根后,显露距跟骨间韧带前束,观察其形态并进行大体测量。韧带长度为两附着部中点之间的距离,宽度与厚度为韧带长度中点处的测量值。(2)12侧成人新鲜下肢标本,离断踝关节,剔除距下关节水平面之上及跟骨结节处的皮肤、肌肉、肌腱等软组织,显露出距骨内外踝关节面及跟骨中后部,距骨及跟骨中后部均用聚甲基丙烯酸甲脂包埋处理。在本实验中设定足的前方为0°,外侧为90°,后方为180°,内侧为270°。将制好的标本固定于万能生物力学机上,标本每旋转30°,沿与足底平行的方向进行力学加载三次(生物力学机以5N/秒的速度向标本施加60N的压力)。然后将其中6侧标本切断前束,另外6侧切断后束,重复前述实验步骤。结果:(1)距跟骨间韧带短而粗韧,位于距跟前后关节之间的跗骨管内,在冠状面上该韧带与跗骨窦方向平均成45°角,其走行方向由后内斜向前外通过跗骨管。该韧带由前、后两束组成。前束纤维起于跟骨沟的后部,跗骨管底壁前缘,附着于跟骨前距关节面和中距关节面后方,外侧与颈韧带相邻,向前上外行,止于距骨颈下方,附骨管顶壁。前束相对于后束更靠近前内方,侧面观可见其较后束更为倾斜。前束外形呈菱形或宽阔条索状。后束纤维附着于跟骨后距关节面前方,跗骨管后外侧部,行向上内或后上内方,止于距骨后跟关节面前方,跗骨管顶壁即距骨沟的底部。后束纤维位于关节运动轴下方,向前与伸肌下支持带的内侧根相邻。该韧带与关节囊前部紧密相贴,实为关节囊局部增厚形成.后束相对于前束更靠近后外方。侧面观见该韧带走行方向与足底平面接近垂直,部分稍偏向后。外形可呈梯形或宽阔的“V”字形。(2)距骨位移以及距骨位移增加量的大小与实验方向有相关性。切断前束后,距骨位移增加量在30°、90°、120°、150°方向上的大小要明显大于其他方向(P0.01),距骨主要是增加了向前外侧的位移。而切断后束后,距骨位移增加量在180°、300°、330°方向上的大小要明显大于其他方向(P0.01),距骨增加的位移主要是向前内侧。结论:(1)距跟骨间韧带宽大肥厚,位于距下关节中部,关节运动轴下方。本实验所观察到的韧带解剖学提示,距跟骨间韧带的作用可能主要为维持关节面紧密接触,并防止距下关节的内、外翻活动。另外,距跟骨间韧带后束相对于前束纤维更靠近后外方,较前束短而粗大,在限制距骨内翻中应该较前束更为重要。(2)距跟骨间韧带前后、束的功能各有侧重,究其解剖特点,后束的功能更重要,手术治疗韧带重建时应以后束为主,并应根据后束的走行进行重建。
[Abstract]:Objective: (1) to observe the anatomical characteristics of the posterior interosseous ligament (interosseous talocalcaneal ligament, ITCL) and analyze its clinical significance. (2) to study the biomechanical characteristics and clinical significance of the anterior and posterior interosseous ligaments of the calcaneus.
Materials and methods: (1) 10% formaldehyde fixed adult normal cadaver foot specimens 20 pairs, without gender, side, to the posterior interosseous ligament, the shape of the posterior fasciculus. After disconnecting the ankle joint, cut off the lateral and lateral ligaments of the outer side of the lower joint and the medial ligament of the medial side of the medial surface and the medial ligament. Bone ligament - calcaneus specimens were dissected to separate the structure of the tarsal sinus and reveal the three roots and the lateral margin of the intercalcaneal ligament under the extensor. The talus was sawed along the posterior edge of the tarsal canal and the posterior part of the tarsal canal was removed. The posterior fasciculus of the ligaments of the calcaneus was revealed, and the shape was observed and the vernier caliper (0.02) was observed. Mm) gross measurement. After the resection of the posterior fasciculus, the posterior fasciculus of the interosseous ligament was exposed and the anterior fascicles of the interosseous ligament were exposed and observed. The length of the ligament length was two between the middle points of the attachment, and the width and thickness were measured at the point of the ligament length. (2) 12 sides of adult fresh lower extremities were isolated. The ankle joint was broken and the soft tissues such as the skin, muscle, and tendon in the calcaneus nodules were removed from the lower part of the lower part of the joint. The medial and lateral malleolus and the middle posterior part of the calcaneus were revealed. The talus and the posterior part of the calcaneus were covered with polymethacrylate methyl acrylate. In this experiment, the front was 0 degrees, the lateral was 90, the rear was 180, and the medial was 27. 0 degrees. The specimen is fixed on the universal biomechanics machine. The specimen is rotated at 30 degrees, and the mechanical load is loaded along the foot parallel to the foot for three times (the pressure of 60N is applied to the specimen at the speed of 5N/ seconds). Then the 6 sides of the specimen are cut off the front bundle and the other 6 sides are cut off and the experimental steps are repeated.
Results: (1) the intercalcaneal ligaments are short and toughened, located in the tarsal canal between the anterior and posterior joints of the heel. The ligament and the tarsal sinus on the coronal plane mean an average of 45 degrees, and the direction from the posterior oblique forward is through the tarsal canal. The ligament consists of the front and the latter two. The anterior bundle fiber is the posterior part of the calcaneus groove, the front of the tarsal canal wall, attached to the front of the tarsal canal. The anterior calcaneal surface and the middle distance of the articular surface, the lateral and the cervical ligaments, go forward and go forward out of the talus neck and attached to the top wall of the canal. The anterior bundle is closer to the anterior side than the posterior bundle. The lateral view is more inclined than the posterior bundle. The anterior bundle is rhombic or broad stripe. The posterior bundle fibers attach to the posterior of the calcaneus to the front of the articular surface and tarsus. The posterior lateral part of the canal, ascending or posterior, stops at the front of the talus posterior articular surface, the top wall of the tarsal canal, the base of the talus sulcus. The posterior bundle fiber is located below the articular motor axis and adjacent to the medial root of the extension of the extensor. The ligament is closely attached to the anterior part of the joint capsule to form the local thickening of the joint capsule. The posterior bundle is relative to the anterior bundle. It is closer to the latter. The lateral view shows that the ligament is close to the foot plane and is slightly biased. The shape can be trapezoid or broad "V". (2) the amount of the talar displacement and the amount of the talus displacement is related to the experimental direction. The increase of the talar displacement is 30, 90, 120 and 150 degrees after cutting off the anterior bundle. The size of the talus is significantly greater than that in the other directions (P0.01). The talus mainly increases the displacement of the anterolateral, and the amount of the increase of the talus displacement in the direction of 180, 300, and 330 is obviously larger than that in the other directions (P0.01), and the increase of the talus is mainly the forward side.
Conclusion: (1) broad hypertrophy of the interosseous ligaments is located in the middle of the subtalar joint and under the motor axis of the joint. The anatomical indication of the ligaments in this experiment may be mainly to maintain close contact with the intercalcaneal ligament, and to prevent the internal and outward movements of the subcalcaneal joints. In addition, the posterior bundle of intercalcaneal ligaments is relative to the anterior bundle fiber. Closer to the latter, shorter and larger than the anterior bundle, it is more important to limit the talus varus. (2) before and after the interosseous ligaments, the functions of the bundles are focused on their anatomy and the function of the posterior fasciculus is more important. The posterior bundle should be the main treatment for the reconstruction of the ligaments and should be rebuilt according to the walking of the posterior bundle.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R322

【参考文献】