踝关节外侧韧带和距下关节韧带修复重建的应用解剖

目的 :为踝关节外侧韧带和距下关节韧带损伤修复重建提供解剖学基础。方法 :在 3 2侧经防腐固定、8侧冷藏新鲜标本上解剖观测踝关节外侧韧带和距下关节韧带及小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带 ,在新鲜标本上摹拟修复术。结果 :小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带解剖位置恒定 ,与踝关节外侧韧带和距下关节韧带相毗邻 ,具有一定的长、宽、厚度 ,可形成移植供体。结论 :①陈旧性踝关节外侧韧带和距下关节韧带的损伤 ,原位修复较难 ,用肌腱转位修复是一种可行的方法 ;②可用腓骨短肌腱修复距腓前和跟腓韧带损伤 ,小趾趾长伸肌腱和第 3腓骨肌腱转位修复距下关节韧带 ,伸肌下支持带可用作加强缝合 ,术式经标本摹拟具有可行性。     

Surgical Considerations in the Treatment of Ankle Instability

OBJECTIVE: To review the surgical indications, techniques, biomechanical testing, and clinical results reported for the most common surgical techniques used to treat ankle instability. DATA SOURCES: We searched MEDLINE from 1960-2001 using the terms ankle instability, functional ankle instability, mechanical ankle instability, ankle ligament surgery, Brostr?m, Chrisman-Snook, and Evans. DATA SYNTHESIS: Although 80% to 85% of acute ankle sprains are successfully treated with a functional ankle-rehabilitation program, the remaining 15% to 20% have recurrent ankle instability and reinjury, necessitating surgical intervention. The fundamentals of the surgical approach to lateral ankle instability are based on the anatomy of the lateral ankle ligaments, the anterior talofibular ligament, and the calcaneofibular ligament. Ankle-instability surgery has been broadly divided into an anatomic repair consisting of an imbrication of the lateral ligamentous complex and an ankle-ligament reconstruction. An ankle-ligament reconstruction weaves a harvested tendon graft, most commonly the peroneus brevis, to augment the lateral ligaments of the ankle. Goals of surgery are to reestablish ankle stability and function without compromising motion and without complications. Anatomic repair and imbrication of the lateral ligament complex with the Gould modification has an 85% to 95% success rate, and the risk of associated nerve injuries is low. This approach provides increased stability by reinforcing local host tissue, preserving subtalar and talocrural motion, eliminating the comorbidity associated with tendon-graft harvest, and offering a quicker functional recovery. One concern in using the anatomic approach is the resultant strength of the repair, although the literature does not support this concern. Ankle-reconstruction procedures that sacrifice tendons are thought to provide a stronger construct, and hence, more stability. This increased stability results in loss of talocrural and subtalar range of motion, prolonging recovery and decreasing sport performance. Adjacent nerve injury is more common with ankle-ligament reconstruction. CONCLUSIONS/RECOMMENDATIONS: Based on the literature, we believe that a modified Brostr?m lateral-ligament repair should be considered the first choice for persistent ankle instability refractory to a functional ankle-rehabilitation protocol. Ankle reconstruction with tendon augmentation should be reserved for patients with generalized ligamentous laxity or long-standing ligamentous insufficiency or as a salvage procedure in a patient with a failed modified Brostr?m lateral-ligament repair.     

The consistent presence of the human accessory deep peroneal nerve

Twenty-four human legs were dissected macroscopically to study the morphological details of the accessory deep peroneal nerve. This nerve arose from the superficial peroneal nerve and descended in the lateral compartment of the leg, deep to peroneus longus along the posterior border of peroneus brevis. Approaching the ankle joint, this nerve passed through the peroneal tunnels to wind around the lateral malleolus; it then crossed beneath the peroneus brevis tendon anteriorly to reach the dorsum of the foot. The accessory deep peroneal nerve was found in every case examined and constantly gave off muscular branches to peroneus brevis and sensory branches to the ankle region. In addition, this nerve occasionally had muscular branches to peroneus longus and extensor digitorum brevis, and sensory branches to the fibula and the foot. The anomalous muscles around the lateral malleolus were also innervated by this nerve. Neither cutaneous branches nor communicating branches with other nerves were found. The present study reveals that the accessory deep peroneal nerve is consistently present and possesses a proper motor and sensory distribution in the lateral region of the leg and ankle. It is not an anomalous nerve as has previously been suggested.     

同种异体肌腱解剖重建修复慢性踝关节不稳

背景：同种异体肌腱解剖重建应用于踝关节修复重建的报道目前较少。 目的：分析运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳的临床疗效。 方法：运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳26例,其中跟腓韧带和距腓前韧带同时损伤或松弛18例,距腓前韧带单独损伤或松弛8例。采用美国足踝外科协定(AOFAS)评分及Good评级评估踝关节功能,并进行患侧与健侧踝关节背伸、跖屈活动度、后足活动度比较。 结果与结论：所有患者治疗后均获得随访,随访时间9-24个月,平均15个月。所有患者均未出现复发性踝关节外侧不稳,美国足踝外科协定(AOFAS)评分：同时修复跟腓韧带和距腓前韧带组,治疗前(48.4±3.7)分,治疗后(88.2±3.8)分,治疗后较治疗前平均提高39.8分;单独修复距腓前韧带组治疗前(50.0±6.4)分,治疗后(89.5±3.4)分,治疗后较治疗前平均提高39.5分。Good评级优 19例,良 6例,可 1例,优良率 96%。患者均无严重并发症。结果提示应用深低温冷冻保存同种异体肌腱解剖重建踝关节外侧韧带治疗踝关节慢性外侧不稳,增大了腱骨接触面积,增加了骨腱愈合的概率,增强了踝关节的稳定性,其远期疗效仍待进一步评估。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

腓骨短肌肌瓣的血供研究与临床应用

目的 了解腓骨短肌血供的解剖学特征,探讨临床应用腓骨短肌肌瓣和以腓骨短肌为蒂的组织瓣内移修复踝周软组织缺损或治疗胫骨骨不连的可行性。 方法 30例经10%福尔马林固定的成人下肢标本,动脉灌注红色乳胶,解剖观察腓骨短肌的血管来源、走行及分布情况;临床上设计切口取腓动脉的弓形动脉分支为蒂,修复踝周软组织缺损和胫骨骨不连患者10例。 结果 腓骨短肌血管呈节段性分布,主要来自腓动脉的弓形动脉,最远侧的分支平均位于外踝上(50.81±5.45) mm;根据腓骨短肌及血供特点,临床设计的腓骨短肌肌瓣应用于10例患者,均获成功。 结论 腓骨短肌血供丰富,逆行腓骨短肌肌瓣血供可靠,是修复踝周软组织缺损和胫骨骨不连的一种理想肌瓣。     

腓骨长肌腱和腘绳肌腱重建前交叉韧带的系统评价

背景:近年报道,腓骨长肌腱可作为重建前交叉韧带新的移植材料,且能取得与腘绳肌腱同等效果,有必要对这2种重建前交叉韧带的移植材料进行系统评价。目的:采用Meta分析方法评价腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床疗效。方法:采用中英文分别在中文数据库(万方医学、中国知网、维普医药、中国生物医学)、英文数据库(Ovid、Pub Med、Web of Science、Embase、Cochrane library)检索腓骨长肌腱和腘绳肌腱重建前交叉韧带的临床对照试验,检索时限从自建库至2019年3月,并由2名评价员通过筛选文献、文献评价、提取数据,并在Revman5.3软件进行Meta分析。结果与结论:(1)通过制定的检索式共检索出中英文文献413篇,最终符合纳入标准10篇,包括647例重建前交叉韧带患者,其中271例使用腓骨长肌腱重建,376例采用腘绳肌腱重建;(2)Meta分析显示:腓骨长肌腱组术后12个月的Lysholm评分、术后6个月的IKDC评分高于腘绳肌腱组(MD=1.23,95%CI[0.31,2.51],P=0.0009;MD=3.19,95%CI[0.07,6.31],P=0.02),术后并发症发生率低于腘绳肌腱组(OR=0.15,95%CI[0.03,0.69],P=0.01);两组术后6,12个月的Tegner评分、关节活动度、关节松弛程度,以及术后6个月的Lysholm评分、术后12个月的IKDC评分比较差异均无显著性意义(P> 0.05);(3)结果表明,腓骨长肌腱重建前交叉韧带的临床效果与腘绳肌腱相当,术后12个月的Lysholm评分、术后6个月的IKDC评分优于腘绳肌腱组,并且可减少术后并发症。临床上可推荐腓骨长肌腱代替腘绳肌腱重建前交叉韧带,但是纳入文献质量限制,需要更高级别的证据。     

Anatomic bases of ankle arthroscopy: study of superficial and deep peroneal nerves around anterolateral and anterocentral approach

We studied the anatomy of the anterolateral and anterocentral portal sites for ankle arthroscopy with reference to the superficial peroneal nerve (SPN) in 29 cadavers (51 ankles) and the deep peroneal nerve (DPN) in 11 cadavers (21 ankles). In relation to the level of division into the medial and intermediate cutaneous nerves and their terminal branches, we classified the structure of the SPN surrounding the ankle into five types. We also identified the point where the SPN and the DPN cross the level of the talocrural joint. 32% of specimens had different SPN division types on the two sides and there was an average of 2 nerves at the level of the talocrural joint. Branches of the SPN were found lateral to the edge of the peroneus tertius tendon in 11.8% of specimens, and at its lateral edge in 27.5%. The DPN and some branches of the SPN were positioned around the lateral edge of the extensor hallucis longus tendon. We consider that the anterolateral portal should be made at least 2 mm lateral to the peroneus tertius tendon to avoid injury to the SPN, since the diameter of the scope is 2.7 mm. The anterocentral portal is unsuitable for arthroscopy due to a high risk of injury to the DPN and branches of the SPN.     

The peroneus quartus muscle: clinical correlation with evolutionary importance

The peroneus quartus (PQ) is an accessory muscle of the peroneal/lateral compartment of the leg. The muscle has often been implicated as a cause of pain in the lateral ankle region, and subluxation or attrition of the peroneal tendons. The present study was aimed at observing the prevalence and morphology of this muscle in human cadavers. Ninety-two embalmed lower limbs were dissected for this study. The PQ muscle was found in 21% of the limbs. In all these limbs it originated from the lower part of the lateral surface of the fibula, the undersurface of peroneus brevis and the posterior intermuscular septum. In the majority of limbs, insertion was on the retrotrochlear eminence of the calcaneus. Taking into account the possibility of this muscle being a cause of lateral ankle pathology, the present study attempts to correlate the findings with the anatomy of the surrounding region. The frequent occurrence of this muscle in humans is suggestive of a progressive evolutionary change to evert the foot in order to assume a bipedal gait.     

Accessory peroneal nerves in the human

The Nervus peroneus profundus accessorius was described by Ruge (1878) in the lower mammals and for the first time identified by Bryce (1897) in man. It is an accessory terminal branch of the superficial peroneal (musculocutaneous) nerve which winds round the lateral malleolus beneath the tendons of the peronei muscles and reaches the dorsum of the foot; there it often supplies the lateral portion of the extensor digitorum brevis muscle. In further investigations this nerve has been traced in 21.2% of subjects resp. in 13.5% of legs. This nerve, however, is not the only accessory branch of the common peroneal nerve: In 14 out of 140 subjects (10%) resp. in 22 out of 280 legs (7.9%) a Nervus peroneus superficialis accessorius has been found. This nerve pierces the anterior crural intermuscular septum either in common with deep peroneal (anterior tibial) nerve or at a lower point. Then it descends in front of the septum rarely giving off muscular branches to the extensor digitorum longus and peroneus tertius muscles; in the lower half of the leg it pierces the crural fascia, passes in front of the ankle joint and becomes the medial cutaneous nerve of the dorsum of the foot. This accessory superficial peroneal nerve may be of importance in surgery of the leg and foot.     

机械性踝关节不稳定患者中腓骨肌功能的表面肌电研究

评价机械性踝关节不稳定中腓骨肌的功能变化.20名单侧机械性踝关节不稳定患者的双侧踝关节在行走过程中模拟内翻动作时接受表面肌电测试,以患侧踝关节作为不稳定组,以同一患者的对侧无症状踝关节作为正常对照组.计算并比较两组踝关节腓骨长肌和腓骨短肌的标化平均波幅和激发时间的差异.在模拟内翻动作中,不稳定组的腓骨长肌和腓骨短肌的标...     

Lateral patellar retinaculum reconstruction for medial patellar instability following lateral retinacular release: A case report

Lateral retinacular release is still being performed in patients with recurrent patellar dislocation as an additional procedure with distal realignment or medial patellofemoral ligament (MPFL) reconstruction. However, consensus remains lacking regarding suitable indications for lateral retinacular release. A 20-year-old woman presented with patellar instability in both medial and lateral directions after undergoing lateral retinacular release with MPFL reconstruction. She displayed inherent systemic joint laxity meeting all seven Carter–Wilkinson criteria. Simultaneous MPFL revision and lateral retinaculum reconstruction successfully improved patellar instability in both directions. This case provides an example of iatrogenic medial patellar instability after failed lateral retinacular release.     

Peroneal tendoscopy – more than just a solitary procedure: case-series

This study presents a series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure at our department in 2013. Patients were clinically diagnosed with peroneal tendons disorders and underwent an additional radiological assessment. Peroneal tendoscopy was carried out in a standard manner before any other arthroscopic or open procedure. Postoperative management depended on the type of pathology. We found 3 peroneus brevis tendon partial tears, 4 cases of a low-lying peroneus brevis muscle belly, 5 cases of tenosynovitis, and 1 case of an intrasheath peroneal tendon subluxation. In 5 patients peroneal tendoscopy was performed as a solitary procedure and in 8 patients as an accessory procedure – together with anterior or posterior ankle arthroscopy, combined posterior and anterior ankle arthroscopy, or open surgery. Both as a solitary and accessory procedure, peroneal tendoscopy was safe and successful, ie, all patients were without any symptoms at one-year follow-up. Our series of patients showed that peroneal tendoscopy can be used both as an independent procedure as well as a valuable accessory procedure.Peroneal tendoscopy or “endoscopy of the peroneal tendon sheath” (1) allows visualization of the peroneal tendons from the myotendinous junction to the peroneal tubercle, while preserving soft anatomical structures and providing a dynamic evaluation of their movement inside the sheath. Peroneal tendoscopy was first described by Van Dijk et al in 1998 (2), but it was rather slowly accepted by the orthopaedic community. Only in the last couple of years has the number of performed peroneal tendoscopies notably increased (1,3-5). Tendoscopy has been additionally popularized and used for evaluation and management of various pathologic conditions of other tendons around the ankle, most frequently for the posterior tibial tendon and Achilles tendon (6-9).The peroneal tendons are situated subcutaneously along the lateral wall of the calcaneus and posterolateral aspect of the fibula. These tendons are easily accessible, which makes them good candidates for tendoscopic treatment of peroneal tendons disorders. Such disorders are frequently clinically expressed as posterolateral ankle pain and include a wide variety of disorders ranging from tenosynovitis, tendon dislocation, and subluxation to peroneal tendon rupture (whether partial or complete) (1,10-13). These conditions often occur combined with other symptoms of intra- or extra-articular pathology of the ankle such as lateral ankle instability, distal fibula fractures, anterior or posterior impingement of the ankle, chondral or osteochondral lesions of the talus, or subtalar malalignment (such as calcaneus varus) (1,10-13).Peroneal tendoscopy is commonly used as an independent, ie, solitary procedure (2,5,11), but there are no literature findings on its use as an accessory procedure. We would like to present our series of 13 patients who underwent peroneal tendoscopy as a solitary or accessory procedure, showing that this procedure may have a dual role in the orthopaedic armamentarium – as a solitary procedure for certain indications, but also as a valuable accessory procedure to some other arthroscopic or open procedures dealing with intra- or extra-articular pathology in or around the ankle.     

膝关节多韧带损伤一期重建后5年随访

背景：前后交叉韧带损伤合并Ⅲ度内侧副韧带损伤严重影响膝关节的稳定性,重建后短期疗效确切,但中期疗效尚不明确。 目的：评估多韧带损伤重建后的中期疗效。 方法：选择40例前后交叉韧带损伤合并Ⅲ度内侧副韧带损伤的患者,男30例,女10例,年龄19-48岁,前后交叉韧带损伤于关节镜下行同种异体肌腱重建,内侧副韧带损伤行带线铆钉修补。重建前后行Lachman试验、IKDC分级、Lysholm评分及KT-1000对患者进行主观和客观评分,以评估重建疗效。 结果与结论：40例患者均获随访,随访时间60个月。重建后患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,Lachman试验、Lysholm膝关节功能评分、IKDC分级评分及KT-1000较重建前明显提高(P < 0.05),提示应用同种异体肌腱重建前后交叉韧带、带线铆钉修补内侧副韧带,能有效恢复膝关节的稳定性,短中期疗效确切。     

Lateral epicondylar femoral avulsion fracture combined with tibial fracture: a counterpart to the arcuate sign

We present a case of femoral avulsion of the lateral collateral ligament (LCL) with complete tear of the posterior cruciate ligament (PCL) and popliteus tendon accompanied by demonstrable posterolateral rotary instability (PLRI) of the knee. A 55-year-old man was involved in a road traffic accident. Radiographs revealed an avulsion fracture of the lateral epicondyle of the femur and a fracture of the tibial shaft. An MRI scan showed the lateral epicondyle was avulsed by the LCL and the popliteus tendon. The PCL signal was absent. The tibial shaft fracture was fixed with an intra medullary nail. Sagging of the tibia, with loss of prominence of tibial tuberosity and a positive posterior drawer test, demonstrated a complete tear of the PCL. The avulsion fracture of the lateral epicondyle was treated by an open reduction and internal fixation with two staples. A ligament can be avulsed at either end, and to our knowledge, this pattern of injury as a counterpart to arcuate sign has never been documented in the literature. It is important not to dismiss a small avulsion fracture around the knee joint as insignificant, as it could indicate the presence of a major ligamentous injury.     

足背皮瓣与足外侧或外踝上哑铃状联合皮瓣设计的解剖基础

目的:为手部复杂外伤并两处皮肤缺损及深部组织损伤外露的修复提供理想的皮瓣供区.方法:40侧动脉灌注红色乳胶的成人下肢标本,解剖观测胫前血管、腓血管穿支降支在踝前的分支、分布、外径及其远端吻合情况.结果:胫前动脉在踝间或踝上向外侧恒定地发出外踝前动脉.根据胫前动脉外踝前支的分出位置、粗细及与腓动脉穿支降支的吻合情况,可将其分成以下四型.两主干血管吻合后下行经外踝前至足背外侧与跗外侧动脉吻合,沿途发出皮支营养胫前踝上和足背外侧.结论:可以在形成以胫前血管为蒂的足背皮瓣同时,以胫前血管的外踝前动脉为血供设计足外侧或外踝上联合皮瓣应用.     

自体肌腱移植修复前交叉韧带合并后外侧角损伤

背景：自体半腱和股薄肌腱移植均可重建交叉韧带和膝关节后外侧角。 目的：分析自体半腱和股薄肌腱移植修复膝关节前交叉韧带合并后外侧角损伤的效果。 方法：将20例膝关节前交叉韧带合并后外侧角损伤患者随机分成两组：实验组在关节镜辅助下应用自体半腱肌、股薄肌一期重建前交叉韧带和加强重建后外侧角韧带;对照组仅采用自体组半腱肌、股薄肌一期重建前交叉韧带。  结果与结论：两组术后Lysom评分较术前明显改善(P < 0.01)。实验组患者在站立、行走和上下楼梯时无与膝关节后外侧不稳相关的过伸位膝关节不稳感,未发现行走时膝关节内甩;关节活动度屈曲100°~135°,伸直0°~10°。对照组中3例在站立,行走和上下楼梯时无与膝关节后外侧不稳相关的过伸位膝关节不稳感,4例行走时出现轻微膝关节内甩;关节活动度屈曲104°~130°,伸直0°~10°。说明用自体肌腱移植重建膝关节前交叉韧带和后外侧结构损伤,能够恢复膝关节后外侧与前后方的稳定性,较单纯重建前交叉韧带效果好。     

Elastic properties of Thiel‐embalmed human ankle tendon and ligament

Thiel embalming is recommended as an alternative to formalin‐based embalming because it preserves tissue elasticity, color, and flexibility in the long term, with low infection and toxicity risk. The degree to which Thiel embalming preserves elasticity has so far been assessed mainly by subjective scoring, with little quantitative verification. The aim of this study is to quantify the effect of Thiel embalming on the elastic properties of human ankle tendons and ligament. Biomechanical tensile tests were carried out on six Thiel‐embalmed samples each of the peroneus longus, peroneus brevis, and calcaneal tendons, and the calcaneofibular ligament, with strain rates of 0.25%s^?1, 2%s^?1, and 8%s^?1. The stress?strain relationship was calculated from the force‐extension response with cross‐sectional area and gauge length. Young's modulus was determined from the stress?strain curve. The results showed that the tendon and ligament elasticity were lower after Thiel embalming than the literature values for fresh nonembalmed tendons and ligament. The biomechanical tensile test showed that the measured elasticity of Thiel‐embalmed tendons and ligaments increased with the strain rate. The Thiel embalming method is useful for preserving human ankle tendons and ligaments for anatomy and surgery teaching and research, but users need to be aware of its softening effects. The method retains the mechanical strain rate effect on tendons and ligament. Clin. Anat. 28:917–924, 2015. © 2015 Wiley Periodicals, Inc.     

Navigation for ankle arthroscopy: anatomical study of the anterolateral portal with reference to the superficial peroneal nerve

We aimed to navigate the surgeon regarding the localization of the main anatomical structures at the anterior part of the ankle joint, in order to find easily the safest anatomical points with reference to the superficial peroneal nerve (SPN), in particular for anterolateral portal placement in ankle arthroscopy. Sixty-three ankles in 36 fresh cadavers were dissected. In all specimens we examined (1) the distance between the SPN bifurcation and the most distal point of the lateral malleolus; and at the level of ankle joint, (2) the number of SPN, (3) the distance between the medial and intermediate dorsal cutaneous nerves, which are branches of the SPN, (4) the localization of the peroneus tertius (PT) tendon in relation to the lateral malleolus, (5) the width of the extensor digitorum longus (EDL) tendon, (6) the relationship of the PT tendon and (7) the relationship of the extensor hallucis longus (EHL) tendon with the SPN. The results were as follows: (1) In 41 ankles with bifurcation (65%) the average distance was 71.8±35.3 mm. (2) There were two SPN branches in 39 (62%), three branches in seven (11%) and one branch in 17 (27%) cases. (3) In 39 ankles with two branches of the SPN, the mean distance was 15.2±7.1 mm. (4) The lateral border of the PT tendon was positioned a mean distance of 20.8±3.3 mm proximal and 25.2±5.8 mm medial to the reference points. (5) The mean width was 10.1±2.9 mm. (6) In 42 ankles (67%) the distance between the lateral border of the PT tendon and the SPN was a mean of 6.2±6.6 mm, median of 3 mm (range 0–22 mm lateral to the tendon). (7) In 56 cases (89%) a branch of the SPN was found a mean of 6.6±4 mm and a median of 6 mm lateral to the EHL tendon, and in seven cases (11%) on the tendon. According to our study, in ankle arthroscopy the risk of the SPN injury is maximal in the 0–3 mm lateral to the PT tendon. To avoid injury to the SPN, the safest placement of the anterolateral portal is 4 mm lateral to the PT tendon.     

踝、距下关节外侧韧带断层与MRI图像的对照研究及临床意义

目的 :为临床MRI诊断踝、距下关节外侧韧带损伤提供断层解剖学依据。方法 :利用低温冰冻技术 ,当足呈自然放松位时 ,将踝、距下关节制成 3 .5mm厚的薄层断层标本 ,并与该区的磁共振图像相对照。结果 :距腓前韧带在轴位 ,跟腓韧带在冠状位和斜轴位 ,距腓后韧带在四个方位 ,颈韧带在冠状位和矢状位 ,距跟骨间韧带在冠状位、矢状位和斜轴位 ,伸肌下支持带浅束在冠状位和矢状位 ,中束和深束在冠状位 ,能清楚观察各韧带的形态和毗邻关系。结论 :在MRI上能清楚显示踝、距下关节外侧区的各条韧带。     

踝关节内侧韧带损伤肌腱重建的三维有限元分析

背景：踝关节内侧三角韧带损伤的重建方法很多,但是目前还没有研究对这些方法进行对比。 目的：三维有限元法对比Wiltberger、Deland、Kitaoka和Hintermann 4种修复方法重建踝关节内侧韧带损伤肌腱后的效果。 方法：建立踝关节三维有限元模型,模型中包括踝周的6块骨性结构、软骨和主要韧带。对模型进行验证试验后,在其基础上建立三角韧带损伤、Wiltberger、Deland、Kitaoka和Hintermann重建模型。在踝关节不同屈曲角度上对模型施加外翻及外旋应力,比较重建后的踝关节生物力学。 结果与结论：4种重建方法均不能使踝关节生物力学完全恢复正常,其中Kitaoka法在恢复踝关节外旋稳定性上最有效,Deland法在恢复踝关节外翻稳定性上最有效。提示4种内侧韧带肌腱重建术式中,Kitaoka和Deland法较其他方法能够相对有效的恢复踝关节旋转稳定性。