跟腓韧带解剖重建的解剖学研究

目的:通过对跟腓韧带(calcaneofibular ligament,CFL)止点相关数据的解剖学测量,为CFL重建提供解剖学依据。方法:采用27例成人尸体踝部标本,保留踝关节上方至少20 cm以及完整足部,男11例,女16例;年龄22～71(41.6±17.2)岁;左侧9例,右侧18例。排除畸形、骨折、发育未完全及退行性病变。对CFL进行解剖观察,测量CFL的形态参数,CFL腓骨侧、跟骨侧在坐标轴的坐标,并测量CFL腓骨侧止点同腓骨尖、CFL跟骨侧止点同跟骨外侧结节的距离,以及CFL同腓骨长轴的夹角。结果:27例人体踝关节标本中,CFL均为单束,CFL长度为(32.83±8.19) mm;CFL腓骨附着区中心点在坐标轴的位置为近端(2.87±1.21) mm,变异系数42.16%;前方(2.08±1.34) mm,变异系数64.42%。CFL跟骨附着区中心点在坐标轴的位置为远端(15.32±5.33) mm,变异系数34.79%;后方(6.38±2.15) mm,变异系数33.86%;CFL腓骨附着区中心点与腓骨尖的距离为(4.81±0.82) mm,CFL跟骨附着区中心点与跟骨外侧结节的距离为(17.25±3.12) mm;CFL同腓骨长轴的夹角为(43±18)°。结论:通过解剖研究发现可以通过踝关节周围解剖标记点来定位CFL腓骨侧、跟骨侧止点,而CFL止点变异较大,在解剖重建时需考虑解剖学特点。

Anatomical study on reconstruction of calcaneus fibula ligament

Objective: To measure anatomical data of calcaneofibular ligament(CFL),relevant data of CFL attachment to provide an anatomical basis for CFL reconstruction.Methods: Twenty-seven adult ankle specimens were selected,including 11 males and 16 females,aged from 22 to 71 years old with an average of (41.6±17.2) years old;9 cases on the left side and 18 cases on the right side. The specimens reserved at least 20 cm above ankle joint and a complete foot,and exclude deformities,fractures,incomplete development and degenerative lesions. CFL was performed detailed anatomical observation,morphological parameters of CFL was measured,and coordinates of fibula side and calcaneal side of CFL in the coordinate axis were measured. The distance between fibula insertion of CFL and fibula tip,distance between calcaneal insertion of CFL and lateral calcaneal nodule,and Angle between CFL and long axis of fibula were also measured.Results: In these 27 specimens,CFL cases were all single bundles and the length of CFL was (32.83 ±8.19) mm. The center point of fibula attachment in CFL was(2.87±1.21) mm proximal with a coefficient of variation of 42.16% and (2.08±1.34) mm anteriorly with a coefficient of variation of 64.42%. The center point of calcaneal attachment region of CFL was located on coordinate axis on the distal end(15.32±5.33) mm,with a coefficient of variation of 34.79%,and the posterior part (6.38±2.15) mm,with a coefficient of variation of 33.86%. The distance between center point of fibula attachment and fibula tip was(4.81±0.82) mm. The distance between center point of calcaneal attachment area of CFL and lateral calcaneal nodules was(17.25±3.12) mm. Angle between CFL and fibula axis is(43±18)°.Conclusion: According to anatomical studies,we could locate the fibula and calcaneal attachment of CFL by anatomical markers around ankle joint. However,the location of CFL attachment has a large variation,and the anatomical characteristics need to be considered in anatomical reconstruction.