(足母)长伸肌腱移位治疗(足母)外翻的应用解剖学

目的:探讨(足母)长伸肌腱移位治疗(足母)外翻的解剖学入路及手术的要点.方法:(1)100例正常足及100例(足母)外翻足,测量(足母)长伸屈肌腱的位置;(2)对20具尸体40足解剖,观察(足母)长伸肌腱、(足母)长屈肌腱、(足母)短伸肌腱、腓浅神经、腓深神经、隐神经及周围血管走行特点,并测量上述结构与解剖标志的相对位置.结果:正常(足母)长伸肌腱的位置在踝横纹处位于胫骨前肌外侧(9.44±4.26)mm,在跖附关节中点外侧(2.00±2.22)mm,跖趾关节中点外侧(1.32±1.46)mm,止点位于末节趾骨基底中点(2.22±2.42)mm范围内,(足母)长屈肌腱在跖趾关节中点外侧(0.44±2.42)mm.在(足母)外翻的患(足母)者中,(足母)长伸肌腱在踝横纹处位于胫骨前肌外侧(9.32±3.46)mm,在跗跖关节中点外侧(3.00±2.22)mm,跖趾关节中点外侧(4.22±2.26)mm,止点位于末节趾骨基底中点(2.02±2.32)mm范围内,(足母)长屈肌腱在跖趾关节中点外侧(3.24±2.32)mm.(足母)趾背侧皮肤由隐神经、腓浅及腓深神经支配.结论:(1)正常与(足母)外翻足的比较中,伸肌腱的位置在足横纹及止点处无明显的差异,在跖附关节及跖趾关节处,外翻足的伸肌腱明显外移(P＜0.05).(足母)长屈肌腱也明显外移(P＜0.05).(2)手术中隐神经终末支易受损伤.(3)伸肌腱内移并止点重建可矫正(足母)外翻.     

拇长伸肌腱损伤的治疗

拇指在手功能中占有重要地位,因此拇长伸肌损伤将影响拇指功能。应予修复,以重建拇指的伸展功能。本文将我院自1984年9月～1994年12月收治的34例疗效,小结如下。 1 临床资料 1.1 一般资料:男27例,女7例,右侧18例,左侧16例,年龄最小18岁,最大53岁,平均27岁。损伤类型:开放性断裂32例,闭合性断裂2例;单纯伤14例,复合伤20例(合并骨、关节;     

长伸肌副腱的解剖学特征及其与外翻畸形的相关性研究

目的观察■长伸肌副腱的解剖学特征,并分析该副腱与■外翻畸形的相关性。方法 90例(左、右各45例)经10%福尔马林溶液灌注固定的人体下肢标本,解剖踇长伸肌及其副腱;采用游标卡尺及量角器,测量副腱的长度、宽度、副腱角及其止点宽度,测量■外翻角;分析上述测量结果与外翻畸形的相关性。结果 (1)86例标本具有■长伸肌副腱,45例标本出现外翻畸形;(2)■长伸肌副腱的数量如下:1支80例、2支5例;与■短伸肌腱共同止点变异1例;(3)■外翻组副腱的长度、宽度、副腱角及止点宽度分别是(85.02±22.27)mm、(1.84±1.64)mm、(7.83±3.28)°及(9.08±2.71)mm;正常组副腱的长度、宽度、副腱角及止点宽度分别是(97.51±30.99)mm、(1.62±0.49)mm、(5.99±3.95)°及(9.09±3.09)mm。与正常组相比,■外翻组副腱角明显增加(P=0.04,t=-2.097)。在所有标本中,副腱角与■外翻角呈正相关(P=0.007,r=0.317)。结论人■长伸肌副腱的出现,与■外翻具有一定相关性,却不是导致■外翻畸形的重要原因。对■长伸肌及其副腱的观察,是对既往研究的补充,也为副腱的临床应用提供理论依据。     

尺侧腕伸肌-拇短伸肌腱移位重建拇对掌功能的应用解剖

目的:研究拇对掌肌、拇短展肌的解剖学特点,探讨符合人体生物力学的拇对掌功能重建的方法。方法:对20侧新鲜成人上肢标本,解剖拇对掌肌、拇短展肌,并建立尺侧腕伸肌-拇短伸肌移位重建拇对掌功能的手术模型。结果:拇短展肌肌纤维方向沿第1掌骨纵轴方向,拇对掌肌肌纤维方向与第1掌骨成一定角度。尺侧腕伸肌-拇短伸肌移位后,测量拇指远侧横纹中点到第3掌骨长轴与掌远侧横纹交点之间的最大距离可达(5.9±0.7)cm。结论(:1)尺侧腕伸肌长度、肌力足以重建拇对掌功能,拇短伸肌腱止点恒定,联合移位后其作用方向与拇短展肌方向一致,且旋前角度足够。(2)以尺侧腕伸肌-拇短伸肌移位重建拇对掌功能是一种符合拇对掌功能生物力学的简单有效的方法。     

长伸肌瓣的解剖学基础

在30个成人下肢标本上观察了长伸肌的形态、血供和神经支配。测得肌长23.1cm。该肌由7-17支胫前动脉横向分支供应,肌下份有腓动脉穿支发出补充,动脉主要从肌的内侧入肌。腓深神经约发出2支分支分布该肌,也是从肌内侧进入肌内。根据观察结果我们认为长仲肌瓣倒置治疗小腿中下份慢性骨髓炎及开放性胫骨骨折,似为较理想的供肌。     

趾长伸肌腱及其滑液囊血管的应用解剖

用40例新鲜成人尸体足标本,作巨微解剖.透明标本和组织切片方法,测量了趾长伸肌腱各项数据,详细报道了其系膜的分支及位置.趾长伸肌腱囊外近侧段的血供为肌血管的延伸;滑液囊及肌腱囊内段血供主要来自胫前动脉、跗上外侧动脉和足背动脉;肌腱囊外远侧段血供来自跖骨背侧动脉。临床切取不同部位带血管蒂趾长伸肌腱时可以此为据.本文还特别强调了跗上外侧动脉在切取滑液囊肌腱复合瓣中的作用.     

小指伸肌腱的解剖学研究进展

应用小指固有伸肌腱（EDQ）转位重建拇对常功能术已成为一种成型且普及的术式，但术后可出现小指伸直不全或障碍并发症，因此从解剖学角度研究小指伸肌腱有重要的临床指导意义。目前，对小指伸肌腱的研究观点尚不一致，其主要分歧表现在对小指指总伸肌腱（EDCs）和腱结合（JT）的看法上，在形态解剖学和应用解剖学上很易混淆。在手背侧伸向小指的伸肌腱主要由EDCs、EDQ及伸指腱器结构组成。本将就EDCs及JT解剖学研究的相关内容作一综述。     

腓肠肌移位重建伸膝功能的应用解剖

在４０侧成人下肢标本上，对腓肠肌形态，血供及其神经作了解剖学观测，在２侧标本上进行摹拟手术实验，结果表明，带血管神经蒂的腓肠肌移位代股四头肌，不必吻接血管，向肌内分离结扎血管束两侧的小分支，可获得血管蒂长度，临床应用３例，经手术后３个月随访，肌力达Ⅲ～Ⅳ级。     

小指指总伸肌腱的解剖学研究及其临床意义

目的:判定和证实小指指总伸肌腱(EDCs)的存在及出现率,预期重新评价对EDCs及腱结合的命名。方法:选用58侧成人防腐手与16侧新鲜手(左右各半),解剖观察第四掌骨背侧指总伸肌腱尺侧束的类型,测量了其伸向小指的腱性结构的倾斜度、长度和宽度;随机解剖了其中8侧前臂,观察EDCs的解剖学特点。结果:①按形态学特点将第四掌骨背侧指总伸肌腱尺侧束分为四大类型,即独立型12.2%(9/74)、分叉型包括“r”亚型48.6%(36/74)与”Y”亚型27.0%(20/74)、分离障碍型5.4%(4/74)和缺如型6.8%(5/74)。②按生物力学特点又将其分为四大类型,即:标准力线型44.6%(33/74)、小力线偏离型37.8%(28/74)、大力线偏离型10.8%(8/74)和缺如型6.8%(5/74)。③除缺如型外,第四掌骨背侧指总伸肌腱尺侧束的尺侧头均以腱束止于小指伸肌腱[93.2%(69/74)]。④小指的指总伸肌腱具有独立的肌腹和单独的神经支配[100%(8/8)]。结论:①第四掌骨背侧指总伸肌腱尺侧束的桡侧头是腱结合,其尺侧头是伸向小指的指总伸肌腱的延续;②EDCs与第四掌骨背侧指总伸肌腱尺侧束是同一解剖结构,其出现率为93.2%(69/74);③分叉型、分离障碍型和缺如型是小指指总伸肌腱解剖变异的不同形式。     

Examination of the accessory tendons of extensor hallucis longus muscle in fetuses

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty-five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16-21 weeks), Group B (22-27 weeks), and Group C (28-34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty-two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL-AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe.     

Anomalous tibialis posterior muscle as an etiologic factor of hallux valgus

The role of an anomalous tibialis posterior (TP) tendon in the etiology of hallux valgus (HV) deformity was investigated in four stages: clinical, anatomical, neurological, and operative. In the clinical stage, the patients were instructed to planter flex and invert the foot to contract the TP tendon. Attempts to correct the deformity passively were not possible and resulted in, moderate pain in all patients (197 feet). When the foot was in dorsiflexion and everted (TP tendon was relaxed) the deformity was easily corrected without any pain in 196 feet (99.5%). In the second stage (anatomical), 10 cadavers (20 feet) with HV deformity and 10 cadavers (20 feet) without any foot deformity were dissected. An abnormal expansion of TP tendon into the oblique part of adductor hallucis was found consistently in all HV feet. The tendinous expansion was absent in all normal feet studied. Also when traction was applied to TP tendon, an increase in the metatarsophalangeal (MP) angle of the big toe was observed in all HV feet, but not in the control group. In the third group (neurological), faradic stimulation was applied to the TP muscle in 7 patients with HV deformity and 7 without deformity. The MP angle was increased in HV patients, but no change was observed in the control group. In the fourth stage, 11 patients (18 feet) surgically operated for HV deformity by proximal metatarsal osteotomy and excision of the band anchoring TP tendon to the oblique part of adductor hallucis. The results were excellent in 10 patients (17 feet) even after a minimum 2.5 year follow-up. Also, in two patients who were operated by different procedures with poor results, the TP tendon was lengthened by Z-plasty and they were completely pain free. Our data show the dynamic role of anomalous expansions of the TP tendon into the oblique part of adductor hallucis muscle in HV patients. We suggest this expansion be excised in addition to other operative procedures selected for the surgical treatment of HV patients. © 1994 Wiley-Liss, Inc.     

恒河猴掌长肌的应用解剖

目的　评价恒河猴掌长肌的实验应用价值。方法　对 30侧恒河猴掌长肌进行解剖 ,测量其肌腹、肌腱的长度、宽度、厚度 ,并对其肌门进行定位。结果　掌长肌肌腹、肌腱均细长 ,且血管、神经变异少。结论　掌长肌是作为骨骼肌游离移植的良好供肌     

Insertion of the tendon of the tibialis anterior muscle in feet with and without hallux valgus

The insertion of the tendon of the tibialis anterior muscle may be related to pathologic changes of the foot and, in particular, hallux valgus. Morphologic data should enable evaluation of such a relationship and perhaps offer a basis for improved therapy. One hundred fifty-six embalmed feet, including 27 with hallux valgus, were examined. The tendon of the tibialis anterior muscle was dissected and measurements were made, including the width of the insertion on the first metatarsal and medial cuneiform. Distal-superficial and proximal-deep slips of the tendon twisted around each other. Two specimens presented with an insertion only on the medial cuneiform; in two other cases the insertion was limited to the first metatarsal; in one case the tendon inserted into the navicular and the medial cuneiform; in all other cases, the tendon inserted into the medial cuneiform and first metatarsal. The insertion was mainly located along the plantar margin of the medial side of the foot; some of the proximal-deep fibers also passed onto the plantar surface. Fibers inserting on the first metatarsal bone can outwardly rotate the first ray, which is opposite to the inward rotation of the first ray in hallux valgus. In all feet with hallux valgus these fibers were present. Therefore, it is unlikely that this deformity develops because of a specific type of insertion of the tendon of the tibialis anterior muscle, and any therapeutic approach altering the attachment of the tibialis anterior tendon would cause no biomechanical improvement.     

The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique

The presence of the palmaris longus muscle (PLM) is highly variable. Rates of absence vary from 0.6% in the Korean population to as high as 63.9% in the Turkish population. The tendon of PLM may be absent on one or both forearms, may have duplicated tendons on one forearm or may be laterally shifted to the extent that the tendon of the PLM lies superficial to that of flexor carpi radialis muscle. Among Black American populations, in which there is usually mixed ancestry, rates of absence are 3.5%. Only two studies have been performed on Black African populations: in Republic of Congo and Uganda, and each showed widely differing rates of absence of 3.0% and 14.6%, respectively. In this study, a total of 890 Black Zimbabwean subjects in Harare aged between 8 and 13 years, were examined for clinical surface anatomy anomalies of the tendon of PLM. The results showed that the tendon of the PLM was absent unilaterally in 0.9% of the population, and bilaterally absent in 0.6% with an overall rate of absence of 1.5%. Other variations noted were a laterally shifted PLM in 1.1% of subjects and duplicated tendons on one forearm, which was the least prevalent anomaly, in 0.2% of subjects. The author proposes a new technique to test the tendon of PLM, which combines resisted thumb abduction and resisted wrist flexion. The proposed technique capitalizes on the role of the PLM as an important abductor of the thumb. Clin. Anat. 22:230–235, 2009. © 2009 Wiley‐Liss, Inc.     

利用跟腱反射重建膀胱功能的应用解剖学研究

目的 :为进行跟腱反射重建膀胱功能的手术时脊神经前根和吻接平面的选择以及脊神经前根的定位提供解剖学依据。方法 :在 2 0具尸体标本上追踪骶丛和坐骨神经的脊神经根来源、相应的脊神经根在坐骨神经和其它神经之间的分布 ,同时观察硬膜内L4～S4脊神经前根排列的位置关系、相互重叠长度和横截面积。结果 :(1)骶丛主要由L4、L5和S1～ 5脊神经根组成 ,其中L5脊神经根 (4 6% )的贡献最大 ;(2 )S2～ 4前根出脊髓的平面均高于L4、L5和S1前根出硬膜的平面 ,前根的横截面积L4(2 .19± 0 .3 9)mm2 、L5(2 .5 8± 0 .5 8)mm2 和S1(2 .19± 0 .42 )mm2 均显著大于S2～ 4前根 ;(3 )在脊髓圆锥平面 ,前后根的辨别和序列的确认较圆锥下容易。结论 :(1)利用跟腱反射重建膀胱功能时宜选用L5前根与S3 或S4前根交叉吻接 ;(2 )吻接平面宜选择在脊髓圆锥处。     

颞骨乳突管（道）的应用解剖

目的：为脑神经和耳神经外科乙状窦手术入路和乳突部开窗术提供解剖学依据。方法：采用游标卡尺等测量、统计９３侧干性颅（颞）骨乳突孔及乳突管（道）的出现率、位置、内径和长度。结果：乳突孔和乳突管的出现率分别为６３．４％和４４％。乳突管多位于乳突部，且右侧多见，其长度平均为８．８（２．０～１４．０）ｍｍ，内径平均为２．５（０．５～４．５）ｍｍ；该管（道）的外口主要位于枕乳缝的前方，其内口位于颅后窝乙状窦沟中部的后缘；该管道的外侧壁至乳突后部表面的间距为０．８±０．１ｃｍ。结论：乳突管为乳突后部深面的一个重要的血管通道，它位于乳突后１／３部分的中、上１／３交界处。该区的手术入路或开窗暴露，可采取外耳门上缘至枕外隆突下缘的连线与乳突后缘向上延长线交点的垂直线之后，且暴露深度应小于０．８ｃｍ。     

旋髂深血管蒂髂骨瓣转位腰骶椎植骨的应用解剖

目的 :为带旋髂深血管蒂髂骨瓣转位腰骶段椎体植骨融合术提供应用解剖学基础。方法 :在3 0具共 60侧灌注红色乳胶的成年尸体上 ,解剖观察旋髂深动脉的起始、走行、分支、分布范围及其毗邻结构 ,测量有关数据 ;摹拟转位情况、测量旋髂深动脉的起点至S1椎体中部、L5～S1椎间、L5椎体中部的距离 ,并用量角器测量旋髂深动脉主干向内转位的角度。结果 :旋髂深动脉起于髂外动脉者占 63 .3 % ,起于股动脉者占 3 6.7%。起点外径 ( 2 .6± 0 .4)mm ,腹壁肌支外径 ( 1.4± 0 .4)mm ,旋髂深动脉的主干延续为髂嵴支 ,外径 ( 1.8± 0 .4)mm ,沿途发出许多小的分支进入髂嵴 ,以最后一个分支作为终点测量其蒂长为( 10 .7± 0 .7)cm ,旋髂深动脉起点至L5椎体中部距离为 ( 11.2± 0 .7)cm ,至L5～S1椎间距离为 ( 10 .1±0 .5 )cm ,至S1椎体中部距离为 ( 9.7± 0 .6)cm ,向内旋转角度为 ( 63 .5± 3 .5 )°。结论 :带旋髂深动脉蒂髂骨瓣转位腰骶段椎体植骨融合具有可行性。