踝三角韧带修复重建的解剖与生物力学的基础研究

目的通过对尸体标本踝三角韧带进行解剖观测,为踝关节韧带修复重建提供解剖与生物力学基础。方法选取成人新鲜尸体足踝标本10例,观察三角韧带的组成、起止、分布,测量各组成部分的长度、宽度及厚度;并在外翻应力位下拍摄X线片,测量踝关节内侧间隙(Mcs),依次切断三角韧带浅层、深层,并重复上述测量。结果踝三角韧带均分为深、浅两层组成,当踝关节韧带处于完整状态时,踝关节在跖屈、中立及背伸位的平均内踝间隙宽度分别为(2.67±0.38)mm、(2.42±0.35)mm、(2.55±0.24)mm。当踝关节处于中立位及最大背伸位时,切断三角韧带浅层后内踝间隙与完整状态相比均无显著性差异(P0.05),而切断三角韧带深层后内踝间隙与完整状态相比有显著性差异(P0.05);而当踝关节处于最大跖屈位时,所有韧带破坏状态后的内踝间隙与韧带完整时相比均无显著性差异(P0.05)。结论(1)踝三角韧带由4条韧带束组成,各韧带束精确起止点的确定是基础研究及临床解剖重建基础。(2)通过综合踝关节跖屈位、中立位及背伸位外旋应力试验结果,可更全面、准确地诊断三角韧带损伤。

Anatomy and biomechanics research of reconstruction of the deltoid ligament

Objective　observation and measurement of the deltoid ligament were performed through cadaver dissection so that anatomical and biomechanical basis for repair and reconstruction of ankle ligament could be provided.　Methods 　10 cases of adult fresh cadaver ankle specimens were dissected for measurement of the length, width and thickness of each component. The X-ray films were taken under the valgus stress. The medial space of the ankle joint (Mcs) was measured, and the anteroposterior space of the ankles was measured. The triangular ligament were incised from in a superficial-to-deep direction, and the measurement was repeated. 　Results　The ankle ligaments were divided into two layers. When the ankle ligaments were in the complete state, the mean ankle space width of the ankle joint was (2.67±0.38) mm, (2.42±0.35) mm and (2.55±0.24) mm in the plantar flexion, neutral and dorsiflexion, respectively. When the ankle joint in the neutral position and the maximum dorsiflexion, no significant difference of the medial malleolus space could be found after the superficial layer of the triangular ligament was cut when compared to that in complete state (P>0.05), whereas significance could be found when the deep layer of the deltoid ligament was cut (P<0.05). When the ankle joint was at the maximum plantar flexion, there was no significant difference (P>0.05) of the medial malleolus spaceafter ligament disruption compared to that in complete state.　Conclusions (1) Triangular ligament consists of four ligament bundles, and having good understanding of the origin and insertion of each ligament bundle is the basis for clinical anatomical reconstruction. (2)Applying external rotation stress test with the ankle in plantar flexion, neutral position and dorsiflexion diagnosis of triangular ligament injury can be more comprehensive and accurate.