外踝及其周围结构的解剖学测量及临床意义

目的　对外踝及其周围结构进行解剖学观测，为外踝骨折内固定及设计外踝定位导向器提供解剖学基础。 方法　①80例（男20对，女20对）干燥腓骨下端形态进行观察分析；②40例（男20，女20）X线片观察外踝的大体形态；③40具（男20，女20）尸体解剖观测外踝前动脉、腓浅神经，腓肠神经毗邻关系。 结果　（1）外踝从上往下骨质逐渐均匀的变薄变窄，近似一个倒立的三角形；（2）骨性标本外踝左右两侧高度、宽度、厚度测量比较差异无统计学意义(P>0.05)；但存在性别差异(P<0.05)。（3）男女X线片上外踝角测量比较差异无统计学意义(P>0.05)；（4）外踝前动脉在距离外踝尖端平面男性(4.30±0.22)cm，女性(4.11±0.6)cm处由胫前动脉发出，先斜向外下方至腓骨下端；然后紧贴腓骨下端及外踝前缘进入足背。（5）腓浅神经主干距离外踝前缘男性(1.59±0.20)cm，女性(1.31±0.64)cm；腓肠神经经过外踝后外下方，距离外踝后缘男性(1.80±0.13)cm，女性(1.62±0.34)cm； 结论　外踝及其周围结构的解剖学测量结果为外踝骨折内固定以及设计外踝定位导向器提供解剖学基础。

Anatomic measurement and clinical significance of lateral malleolus and surrounding structures

Objective　To provide applied anatomical basis for design of lateral alignment guide and lateral malleolus fracture fixation, the lateral malleolus and the surrounding anatomical structures were observed and measured.　Methods　(1) 80 cases (male 20 pairs and female 20 pairs) of dried fibula were observed and analyzed. (2) 40 cases (male 20 and female 20) underwent plain radiography for observation of the general morphology of the lateral malleolus,3. the anterior lateral malleolus artery, the superficial peroneal nerve and the sural nerve were observed in 40 specimens(male 20 and female 20).　Results　(1) From up down, the lateral malleolus gradually tapered off, assuming similarly an inverted triangle; (2) No statistical significance of the height, width and thickness could be detected between the lateral malleolus of the left and right sides in bony specimens, but gender difference of the above mentioned parameters could be found. （3）The lateral malleolus angle was not significantly different between male and female in X-ray (P>0.05). （4）The anterior lateral malleolar artery originated from the anterior tibial artery (4.30±0.22) cm and (4.11±0.6) cm above the tip of the lateral malleolus in male and female, respectively, which then coursed obliquely downward to the lower part of the fibula and continued to travel in close contact with the fibula and the anterior aspect of the lateral malleolus to enter the dorsum of the foot. （5）The superficial peroneal nerve distribution (1.59±0.20) cm in male and (1.31±0.64) cm in female from the anterior margin of the lateral malleolus; The sural nerve traveled posteroinferior to the lateral malleolus, being located (1.80±0.13) cm and (1.62±0.34) cm posterior to the posterior margin of edge of the lateral malleolus in male and female, respectively.　Conclusions 　 According reliable and relevant parameters obtained from measurement of the lateral malleolus and the surrounding anatomical structures can provide anatomical basis for the design of lateral malleolus fracture fixation and alignment guide.