第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带的基础与临床

目的　带血供第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带提供解剖学基础。 方法　在6例经防腐固定的成人下肢标本及6 例新鲜标本上观测距腓前韧带起止点及行径，第2跗跖背侧韧带的解剖形态与起止点，在新鲜标本上模拟重建手术。 结果　第2跗跖背侧韧带位置恒定，解剖层次表浅，切取方便，第2楔骨-跗跖背侧韧带-跖骨瓣的背侧韧带长度(4.1±0.4) cm，距腓韧带长度(2.4±0.5) cm。(1)第2楔骨-跗跖背侧韧带-跖骨瓣的背侧韧带具有足够的长度，可形成移植供体；(2)带血供第2楔骨-跗跖背侧韧带-跖骨瓣复合体两端分别与骨创面固定，容易成活和恢复功能；(3)临床应用12例,全部病人随访4月~2年，重建后距腓前韧带可纠正踝内翻畸形，骨瓣愈合时间为2~3个月，踝关节功能满意，无再断裂并发症。 结论　骨瓣修整后的背侧韧带重建距腓前韧带有术式简单，重建韧带结构接近正常，受区损伤小等优点；采用带血供第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带具有可行性。

Second cuneiform bone-dorsal tarsometatarsal ligaments-metatarsal flap for reconstruction of basic and clinical talofibular ligament

Objective　To provide anatomical basis for blood supply of second cuneiform bone - dorsal tarsometatarsal ligaments - metatarsal flap to reconstruction talofibular ligament.　Methods　In 6 embalmed adult cadavers and 6 fresh specimens the origin, insertion and course of the talofibular ligament, the origin, insertion and course of the 2nd dorsal tarsometatarsal ligament were observed. simulated reconstruction surgery were conducted on fresh specimens.　Result The tarsometatarsal ligaments was consistent and superficially located and easy to harvest, the second cuneiform bone- dorsal tarsometatarsal ligaments-dorsal metatarsal ligament flap was (4.1±0.4) cm in length, while the talofibular ligament length was (2.4±0.5) cm in length.（1）The dorsal ligaments from second cuneiform bone - dorsal tarsometatarsal ligaments - metatarsal flap had sufficient length to serve as a transplant donor site. (2) Second cuneiform bone - dorsal tarsometatarsal ligaments - metatarsal flap were fixed at both ends to the bone wounds, making it easy to survive and restore functions. (3) the flap was clinically applied in 12 cases. All patients were followed up for 4 months to 2 years ,and it was found that the reconstituted talofibular ligament can correct varus deformity of the ankle; the average bone healing time was 2 to 3 months; all patients were satisfied with the ankle function and no further fracture complications were encountered.　Conclusion　The second cuneiform bone - dorsal tarsometatarsal ligaments - metatarsal flap is similar in anatomical structure to talofibular ligamet. The reconstruction surgery is simple in procedure and minimal in donor site trauma. Using second cuneiform bone - dorsal tarsometatarsal ligaments -metatarsal flap for reconstruction of the talofibular ligament is feasible anatomically and clinically.