腱旁组织有关的应用解剖学

通过血管注射,对17只新鲜成年男性尸体上肢的屈指肌腱的腱旁组织,及其血管来源和血液供应进行了研究。腱旁组织是无滑膜腱的血供来源,在肌腱通过关节部位,腱旁组织特化为滑液囊,指腱鞘、腱系膜等结构。腱旁组织的血管网与滑液囊壁、指腱鞘外面及腱外膜的血管网延续,构成了一个相对独立的血供系统。     

腓肠肌腱膜V—Y延长结合带线锚钉修复陈旧性跟腱断裂

目的探讨腓肠肌腱膜V—Y延长结合带线锚钉修复陈旧性跟腱断裂的手术方法及疗效。方法 2013年7月~2015年11月,采用腓肠肌腱膜V—Y延长结合带线锚钉修复陈旧性跟腱断裂7例,采用美国足踝外科协会(American Orthopaedic Foot and Ankle Society,AOFAS)评分,和疼痛视觉模拟(Visual Analogue Scale,VAS)评分,对患者术前及末次随访时进行功能和疗效评判。结果患者术后末次随访时AOFAS评分由术前69.34±4.97分增至90.98±2.03分,VAS评分由术前2.74±1.56分降至0.78±0.71分,差异具有统计学意义(0.05)。结论腓肠肌腱膜V—Y延长结合带线锚钉可有效的修复陈旧性跟腱断裂,纠正足部畸形。     

Development of the human Achilles tendon enthesis organ

The attachment of the Achilles tendon is part of an ‘enthesis organ’ that reduces stress concentration at the hard–soft tissue interface. The organ also includes opposing sesamoid and periosteal fibrocartilages, a bursa and Kager's fat pad. In addition, the deep crural and plantar fasciae contribute to Achilles stress dissipation and could also be regarded as components. Here we describe the sequence in which these various tissues differentiate. Serial sections of feet from spontaneously aborted foetuses (crown rump lengths 22–322 mm) were examined. All slides formed part of an existing collection of histologically sectioned embryological material, obtained under Spanish law and housed in the Universidad Complutense, Madrid. From the earliest stages, it was evident that the Achilles tendon and plantar fascia had a mutual attachment to the calcaneal perichondrium. The first components of the enthesis organ to appear (in the 45‐mm foetus) were the retrocalcaneal bursa and the crural fascia. The former developed by cavitation within the mesenchyme that later gave rise to Kager's fat pad. The tip of the putative fat pad protruded into the developing bursa in the 110‐mm foetus and fully differentiated adipocytes were apparent in the 17‐mm foetus. All three fibrocartilages were first recognisable in the 332‐mm foetus – at which time adipogenesis had commenced in the heel fat pad. The sequence in which the various elements became apparent suggests that bursal formation and the appearance of the crural fascia may be necessary to facilitate the foot movements that subsequently lead to fibrocartilage differentiation. The later commencement of adipogenesis in the heel than in Kager's pad probably reflects the non‐weight environment in utero. The direct continuity between plantar fascia and Achilles tendon that is characteristic of the adult reflects the initial attachment of both structures to the calcaneal perichondrium rather than to the skeletal anlagen itself.     

吻合血管大收肌腱复合组织瓣移植修复跟腱缺损的应用解剖

目的 :为吻合血管的大收肌腱复合组织瓣移植修复跟腱缺损新术式提供解剖学依据。方法 :在 40侧经动脉灌注红色乳胶成人尸体下肢标本上 ,对膝降动脉的起始、走行、分支和分布 ,以及大收肌腱的形态、血供等解剖观察。结果 :膝降动脉 95 %起于股动脉 ,起始处距收肌结节 7.8± 0 .8cm ,膝降动脉90 %发出隐支、股内侧肌支和关节支 ,膝降动脉和关节支起始外径分别为 :1.9± 0 .4mm和 1.4± 0 .4mm ,关节支伴大收肌腱下行 ,分支供养大收肌腱及股骨内侧髁。结论 :以膝降血管为蒂可形成大收肌腱骨皮复合组织瓣 ,吻合血管移植可修复不同类型的跟腱缺损 ,术式简便易行 ,供区损伤小。     

吻合膝上外侧血管髂胫束移植修复跟腱缺损的应用解剖

目的 :为带血供髂胫束移植修复跟腱缺损新术式提供解剖学基础。方法 :在 40侧经动脉灌注红色乳胶的成人下肢标本上 ,对膝上外侧动脉的起源、走行、分支、分布、吻合以及髂胫束的血供来源等进行解剖观测。结果 :膝上外侧动脉于腓骨头上缘近侧垂直距离 5 .2± 0 .9cm处起自动脉 ,起始外径1.8± 0 .4mm ,向外上蜿蜒走行 3 .0± 0 .2cm ,分为升、降支。升支起始外径 1.2± 0 .4mm ,发出肌支和髂胫束穿支 ;降支起始外径 1.2± 0 .4mm ,发出肌支、3～ 5支股骨外侧髁骨膜支及髂胫束穿支。其中低位髂胫束穿支距腓骨头上缘距离 6.1± 1.1cm ,膝上外侧血管髂胫束瓣蒂长 4.9± 1.0cm。结论 :根据膝上外侧血管的分支、分布特点 ,设计吻合血管髂胫束游离移植修复跟腱缺损的术式具有可行性。     

小腿有关肌腱转位修复跟腱的生物力学评价

目的：为临床选用自体肌腱转位修复跟腱提供生物力学依据。方法：选用防腐固定成年和新鲜青年下肢各７例。制备拉伸试件，在ＳＷＤ－１０型材料试验机上，进行单向拉伸破坏实验。结果：跟腱、腓骨长肌腱、腓骨短肌腱、胫骨后肌腱及展肌腱固定组分别为２２９２．６Ｎ、１０２０．５Ｎ、７５２．０Ｎ、９３８．９Ｎ和７２１．３Ｎ，新鲜组分别为１９２７．１Ｎ、８１９．５Ｎ、３４６．７Ｎ、６９９．７Ｎ、３０３．８Ｎ。结论：腓骨长肌腱是跟腱缺损修复术较理想的自体材料。     

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

The Achilles tendon is the most frequently ruptured tendon in the lower limb and accounts for almost 20% of all large tendon injuries. Despite numerous published studies describing its blood supply, there has been no uniformity in describing its topography. The current study comprises a detailed anatomical study of both the intrinsic and extrinsic arterial supply of the Achilles tendon, providing the detail sought from studies calling for improved planning of surgical procedures where damage to the vascularity of the Achilles tendon is likely. A dissection, microdissection, histological, and angiographic study was undertaken on 20 cadaveric lower limbs from 16 fresh and four embalmed cadavers. The Achilles tendon is supplied by two arteries, the posterior tibial and peroneal arteries. Three vascular territories were identified, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. The midsection of the Achilles tendon was markedly more hypovascular that the rest of the tendon. The Achilles tendon is at highest risk of rupture and surgical complications at its midsection. Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and approaches to the tendon operatively should consider the route of supply by the peroneal artery to this susceptible part of the tendon. Clin. Anat. 22:377–385, 2009. © 2009 Wiley‐Liss, Inc.     

全镜下跟腱清理与止点增强治疗跟腱部分撕裂的Haglund综合征的疗效对比

目的 比较全关节镜下跟腱清理与跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征患者的临床疗效。方法 回顾性分析2016年1月至2021年3月在青县人民医院应用全关节镜下治疗跟腱部分撕裂的Haglund综合征的24例患者资料,依据手术方式不同分为关节镜下跟腱止点清理组（A组）和关节镜下跟腱止点清理+跟腱止点增强重建组（B组）,每组各12例。术后定期随访,采用疼痛视觉模拟（VAS）评分、美国足踝外科协会（AOFAS）足踝功能评分及维多利亚体育研究所评分（VISA-A）评估治疗结果,进行观察对比。结果 患者平均随访时间（7.5±0.8）个月,末次随访均不存在后足跟肿痛、跟腱再次断裂等并发症。所有患者症状较术前均得到缓解。A组和B组的VAS评分、AOFAS评分、VISA-A评分均较术前有所改善;然而A组和B组术前及术后6个月的VAS、AOFAS、VISA-A评分对比,差异无统计学意义（P>0.05）;B组术后1、3个月的VAS、AOFAS、VISA-A评分优于A组,差异有统计学意义（P<0.05）。结论 全关节镜下跟腱止点增强重建治疗跟腱部分撕裂的Haglund综合征,较关节...     

带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损

目的探讨带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损的效果。方法复合皮瓣修复跟腱并皮肤缺损6例,其中3例跟腱背侧部分缺损,2例跟腱内侧部分缺损,1例跟腱完全缺损。切取带腓肠肌肌腱的腓肠神经营养血管复合皮瓣时,保持肌腱与皮瓣深筋膜的联系。皮瓣大小7cm×5cm～11cm×10cm,腓肠肌肌腱大小为5cm×3cm～9cm×4cm。结果6例皮瓣均完全成活,感染控制;6例术后随访3～50个月,皮瓣外观满意,无跟腱再断裂者。患侧踝关节屈伸范围基本正常,功能评定,优5例,良1例。结论带腓肠肌肌腱的腓肠神经营养血管复合皮瓣修复跟腱并皮肤缺损具有手术操作简单,术后跟腱粘连轻,功能恢复好的优点。     

The twisted structure of the rat Achilles tendon

The rat is frequently used as a model to study the characteristics, aetiology and pathology of the Achilles tendon. However, though the structure of the human Achilles tendon has been extensively investigated, the anatomical structure of the rat Achilles tendon remains unclear, which impedes the ability to use rats to study Achilles tendinopathy. The purpose of this study was to reveal the structure of the rat Achilles tendon and to explore its similarities with the human Achilles tendon through an anatomical dissection of 80 rat Achilles tendons (40 female, 40 male). This study found that the subtendons of the rat Achilles tendon originating from the triceps surae muscle were twisted, and each subtendon also had its own torsion. The extent of these two types of torsion could be very different between rats. Alterations in this torsion may result in distinct stress fields in the Achilles tendon, which may play a critical role in the pathogenesis of Achilles tendinopathy. This study provides an important basis to support the use of rats as model animals to investigate the characteristics of the human Achilles tendon and Achilles tendinopathy.     

应用自制简易装置微创治疗跟腱断裂疗效分析

目的 评估应用自制简易装置微创治疗跟腱断裂的疗效.方法 对2016年1月至2018年6月期间收治的急性跟腱断裂患者共11例进行回顾性分析.利用自制的工具小切口修补跟腱断端,统计手术时间,切口长度,出血量,术后切口感染率、皮肤坏死率、术后腓肠神经损伤率、再断裂率,住院时间,记录术后6、12、18个月的AOFAS评分.结果...     

双蒂腓肠肌皮瓣修复跟腱复合缺损的改进及其解剖学依据

目的改进双蒂腓肠肌皮瓣下滑术式,细化其修复跟腱复合组织缺损适应证,减少供区创伤。方法0侧成人下肢标本,模拟只切断比目鱼肌近端附着点、保留跟腱远端完整性的双蒂腓肠肌V-Y推进皮瓣,测定膝关节不同屈曲角度下皮瓣下滑的距离。结果在膝关节屈曲0°、30°、60°、90°时,上述方法后双蒂腓肠肌皮瓣下滑的平均距离分别为(13.83±5.31)mm、(25.00±2.83)mm、(32.67±4.41)mm、(39.50±4.85)mm。结论双蒂腓肠肌V-Y下滑术式中只切断比目鱼肌近端附着点后重建,保留跟腱远端完整性的这一改进在解剖学上是可行的,适用于40mm以内的成人跟腱复合组织缺损。     

Microprocessor-based instrument for Achilles tendon reflex measurements

A microprocessor-based system for automatic measuring and evaluation of the reflex of the Achilles tendon is described. An optoelectric transducer for detecting foot movement was used. The electronic equipment enables the simultaneous measurement of three time intervals of the reflex curve calculated from the moment of stimulation. A microprocessor controls the measuring process, communicates with the operator, stores data to the memory, evaluates the results of several measurements and sorts the patient into one of the following groups: (i) reflex normal, (ii) reflex abnormal. The measurement of the time intervals of the Achilles tendon reflex represents an important diagnostic procedure in therapy of the thyroid gland.     

Anatomy of the Achilles tendon (tendo calcaneus) with respect to tendon thickness measurements

Summary 267 normal controls of different ages underwent achilles tendon thickness measurements by ultrasonography (US) for reference. 96 recruits and 10 young women additionally underwent magnetic resonance imaging of the achilles tendons and calves for more systematic evaluation of the factors influencing tendon thickness. Children under 10 had a tendon thickness (mean±SD) of 4.6±0.8 mm, 10–17 year-olds 6.1±0.8 mm, 18–30 year-olds 6.3±0.5 mm and over 30 year-olds 6.9±1.0 mm. Women had slightly thinner tendons than men, but the difference was statistically significant only in the oldest age group. Normal variation in shape of the tendon caused up to a 25% variation in the measured thickness values. In the large sample of recruits a statistically significant correlation was found between the tendon thickness and body height. Differences in population height could account for the measured differences in normal achilles tendon thickness found in studies on Japanese subjects compared with studies on European and American subjects.

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Anatomie du tendon calcanéen (tendon d'Achille) : mesures de l'épaisseur du tendon

Résumé L'épaisseur du tendon calcanéen de 267 sujets normaux d'âges différents a été mesurée par échographie. 96 recrues et 10 jeunes femmes ont en plus subi une imagerie par résonance magnétique des tendons calcanéens et des mollets pour une évaluation plus systématique des facteurs pouvant influencer l'épaisseur du tendon. L'épaisseur du tendon était de 4,6±0,8 mm chez les enfants de moins de 10 ans, de 6,1±0,8 mm chez les adolescents de 10 à 17 ans, de 6,3±0,5 mm chez les adultes de 18 à 30 ans, et de 6,9±1,0 mm chez ceux de plus de 30 ans. Les femmes avaient des tendons légèrement plus fins que les hommes, mais la différence n'etait pas statistiquement significative, sauf dans la tranche d'âge la plus élevée. Les variations normales de forme du tendon provoquaient des variations de plus de 25 % des valeurs de l'épaisseur tendineuse. Dans la population des recrues, une corrélation statistiquement significative existait entre l'épaisseur tendineuse et la taille. Des différences de taille dans la population étudiée peuvent expliquer les différences observées lors des mesures d'épaisseur de tendon calcanéen effectuées sur des sujets japonais d'une part, des sujets européens et américains d'autre part.

     

Anatomic relationship of heel spur to surrounding soft tissues: greater variability than previously reported

The stimulating factor for the development of heel spur (calcaneal exostosis) is controversial. In a sample of elderly cadaveric specimens, using radiographic, gross morphological, and histological investigation, we demonstrate that heel spurs are generally not found in the trajectory of traction from the plantar aponeurosis enthesis or plantar muscles. Rather, they are variably associated with soft tissues including loose connective tissue, fibrocartilage, muscle, and aponeurosis. Furthermore, the bony trabeculae of the spur are not aligned in the direction of soft tissue traction, but rather in the direction of stress on the calcaneus during walking and standing. These results substantiate the view that the heel spur may be a skeletal response to stress and may serve to protect the bone against the development of microfractures.     

Role of moderate exercising on Achilles tendon collagen crimping patterns and proteoglycans

Abstract

In this study, the morphological and morphometric changes in the collagen crimping pattern of Achilles tendon and metabolism/expression of tenocytes explanted from tendons of running (RUN) and sedentary (SED) rats were investigated to assess the effects of 12 weeks moderate running exercise. The number, the top angle width and the base length of each crimp in three different regions (proximal, central and distal) of RUN and SED tendons were measured with a polarized light microscope. The most significant morphometric differences in the crimps were detectable in the central region of the RUN tendons. In this region, crimps were fewer, larger and more flattened than those of other regions as a consequence of a functional adaptation of extracellular matrix to running, in order to increase tendon stiffness and force transmission efficiency. Conversely, the top angle width of the crimps reduced in proximal and distal regions of the RUN tendons, suggesting that these crimps might act as more reactive mechanical springs, able to store and improve the release of the stored strain energy in most loaded regions. Tenocytes explanted from Achilles tendons of both RUN and SED groups were cultured. Running influenced tenocytes which showed a significant increase in collagen type-I synthesis and proteoglycans production, suggesting enhancement of the loading transmission efficiency and facilitate inter-fibril and inter-fiber sliding.     

改良膝降动脉为蒂大收肌腱骨皮瓣修复跟腱复合组织缺损

目的　探讨改良膝降动脉为蒂的大收肌腱骨皮瓣修复跟区跟腱复合组织缺损方法及效果。 方法　对3例外伤致足跟区跟腱止点伴跟骨及皮肤软组织缺损的患者,采用以膝降动脉为蒂的隐动脉穿支皮瓣修复跟区皮肤缺损,以膝降动脉关节支为蒂的大收肌腱骨瓣移植修复跟区复合组织缺损。其中跟区皮肤缺损面积为7 cm×9 cm～5 cm×7 cm ,跟腱缺损长度为6～8 cm,切取皮瓣面积为8 cm×10 cm～6 cm×8 cm ,大收肌腱切取长度为7～9 cm。 结果　3例复合组织瓣全部顺利成活,术后随访6～12个月,皮瓣感觉恢复S3～4,双足提踵试验及单足提踵试验均阴性,步态恢复均正常。 结论　应用隐动脉穿支设计皮瓣,皮瓣设计于大腿内侧, 改良了隐动脉皮瓣设计于小腿内侧,造成切口过大,分离血管蒂较长等缺点,疗效可靠,是目前较理想修复方法。     

Evidence for an elongated Achilles tendon in Australopithecus

Modern humans have the longest Achilles tendon (AT) of all the living primates. It has been proposed that this anatomy increases locomotor efficiency and that its elongation may have played a crucial role in the origin and early evolution of the genus Homo. Unfortunately, determining the length of the AT in extinct hominins has been difficult as tendons do not fossilize. Several methods have been proposed for estimating the length of the AT from calcaneal morphology, but the results have been inconclusive. This study tested the relationship between the area of the superior calcaneal facet and AT length in extant primates. The superior facet is instructive because it anchors the retrocalcaneal bursa, a soft tissue structure which helps to reduce friction between the AT and the calcaneus. Calcanei from 145 extant anthropoid primates from 12 genera were photographed in posterior view and the relative superior facet size quantified. AT lengths were obtained from published sources. The relative area of the superior facet is predictive of AT length in primates (R² = 0.83; p < .001) and differs significantly between the great apes and humans (p < 0.001). When applied to fossil Australopithecus calcanei, our results suggest that australopiths possessed a longer, more human-like, AT than previously thought. These findings have important implications for the locomotor capabilities of Australopithecus, including their capacity for endurance running and climbing.     

Structure of the Achilles tendon at the insertion on the calcaneal tuberosity

Findings on the twisting structure and insertional location of the AT on the calcaneal tuberosity are inconsistent. Therefore, to obtain a better understanding of the mechanisms underlying insertional Achilles tendinopathy, clarification of the anatomy of the twisting structure and location of the AT insertion onto the calcaneal tuberosity is important. The purpose of this study was to reveal the twisted structure of the AT and the location of its insertion onto the calcaneal tuberosity using Japanese cadavers. The study was conducted using 132 legs from 74 cadavers (mean age at death, 78.3 ± 11.1 years; 87 sides from men, 45 from women). Only soleus (Sol) attached to the deep layer of the calcaneal tuberosity was classified as least twist (Type I), both the lateral head of the gastrocnemius (LG) and Sol attached to the deep layer of the calcaneal tuberosity were classified as moderate twist (Type II), and only LG attached to the deep layer of the calcaneal tuberosity was classified as extreme twist (Type III). The Achilles tendon insertion onto the calcaneal tuberosity was classified as a superior, middle or inferior facet. Twist structure was Type I (least) in 31 legs (24%), Type II (moderate) in 87 legs (67%), and Type III (extreme) in 12 legs (9%). A comparison between males and females revealed that among men, 20 legs (24%) were Type I, 57 legs (67%) Type II, and eight legs (9%) Type III. Among women, 11 legs (24%) were Type I, 30 legs (67%) Type II, and four legs (9%) Type III. No significant differences were apparent between sexes. The fascicles of the Achilles tendon attach mainly in the middle facet. Anterior fibers of the Achilles tendon, where insertional Achilles tendinopathy is most likely, are Sol in Type I, LG and Sol in Type II, and LG only in Type III. This suggests the possibility that a different strain is produced in the anterior fibers of the Achilles tendon (calcaneal side) where insertional Achilles tendinopathy is most likely to occur in each type. We look forward to elucidating the mechanisms generating insertional Achilles tendinopathy in future biomedical studies based on the present results.     

Reconstruction of a patellar tendon with Achilles tendon allograft for severe patellar infera — A case report

Severe patellar infera accompanied by pathologic shortening and fibrosis of the patellar tendon is relatively an uncommmon condition but can cause recalcitrant joint stiffness and limited range of motion after knee surgery or injury. This report presents a case of a 49-year-old male with severe patellar infera and limping due to joint stiffness after three-time knee surgeries. We report a successful outcome along with a finding of the well-healed allograft after the reconstruction of a patellar tendon using Achilles tendon-bone allograft.