国人外踝韧带的应用解剖学观测

目的:探讨国人踝关节外踝韧带的解剖学特征，为临床踝关节扭伤相关疾病的诊治提供解剖学依据。方法:对43侧成年国人尸体踝关节标本外踝韧带进行应用解剖观察，其中男34侧、女9侧，左踝20侧、右踝23侧。观察距腓前韧带(ATFL)、跟腓韧带(CFL)、外侧距跟韧带(LTCL)的形态学特征，以及各韧带止点的相互关系，并在中立位上...

Applied anatomy of lateral ankle ligaments in Chinese ankle joint specimens

Objective To explore the anatomical characteristics of the main stable structures of lateral malleolus of Chinese ankle specimens and to provide anatomical basis for diagnosis and treatment, especially the surgical intervention of ankle sprain-related diseases.Methods A total of 43 adult Chinese ankle joints, including 34 males and 9 females and 20 left and 23 right ankles, were dissected in the study to observe the morphological characteristics of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and lateral talocalcaneal ligament (LTCL) and their positional relationship. Their basic parameters were measured in a neutral position of ankle joints.Results Among the dissected ankle joints, ATFL with double bundles was most common (28 specimens), accounting for 65.1%(28/43). Single-bundle and triple-bundle ATFL accounted for 27.9% (12/43) and 7% (3/43), respectively. There were 11 ankles (type1, 25.6%) showed no fibre connection of the ATFL and CFL at the fibular origin, 25 ankles (type 2, 58.1%) showed partial fibre connection, 7 ankles showed total connection (type 3, 16.3%). Among the ankles of single ATFL, type 1 accounted for 5/12, and the type 2 accounted for 67.9% (19/28) and 2/3 in ankles with double and triple bundles, respectively. The length of the inferior bundle in double-bundle ATFL was (15.15±2.84) mm at the neutral position and was significantly shorter than that of the single-bundle (18.83±3.07) mm, superior bundle in double-bundle ATFL (18.98±2.16) mm, and superior (19.65±1.72) mm and middle (18.25±1.52) mm bundles in triple-bundle ATFL (F=7.812, P＜0.01). However, no significant difference was observed compared with the average length of double-bundle (17.07±2.16) mm and triple-bundle (18.52±1.47) mm ATFL (F=2.433, P＞0.05). The width of single-bundle ATFL was (6.91±1.21) mm, which was wider than that of double- or triple-bundle ATFL (F=12.211, P＜0.01) but narrower than the whole width of double- or triple-bundle ATFL (F=29.073, P＜0.01). The CFL presented as a single bundle in all specimens, and the average length, width, and thickness were (26.98±2.41), (5.03±0.89), and (2.33±0.50) mm, respectively. There was no significant difference in length, width and thickness among different ATFL types(F=0.584, 0.248, 1.249, all P values＞0.05). LTCL was present in 46.5% (20/43) of ankle joint specimens (all were single bundle) and directly adhered to ATFL or (and) CFL or with thin fibrous tissue at their insertions. Its average length was (25.99±1.86) mm, and the average width was (4.26±0.47) mm.Conclusions ATFL in Chinese is mainly composed of two bundles of fibers, followed by single and triple bundles. The dimensional parameters of ATFL and CFL and their positional relationship on fibula can provide anatomical basis for the repair of lateral malleolus ligaments. Meanwhile, using the LTCL to (augmented) repair lateral malleolus ligament clinically should be considered as variation of this ligament.