国人外踝韧带的应用解剖学观测

doi:10.3760/cma.j.cn101202-20200430-00153

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摘要目的探讨国人踝关节外踝韧带的解剖学特征,为临床踝关节扭伤相关疾病的诊治提供解剖学依据。方法对43侧成年国人尸体踝关节标本外踝韧带进行应用解剖观察,其中男34侧、女9侧,左踝20侧、右踝23侧。观察距腓前韧带(ATFL)、跟腓韧带(CFL)、外侧距跟韧带(LTCL)的形态学特征,以及各韧带止点的相互关系,并在中立位上测量其长、宽、厚等基本参数。结果 43侧踝关节标本外踝韧带解剖发现,ATFL呈双束者最多,占65.1%(28/43),单束和三束者分别占27.9%(12/43)和7.0%(3/43)。ATFL和CFL在腓骨起点处无纤维联系者11踝(1型,25.6%),存在部分纤维融合者25踝(2型,58.1%),纤维完全融合者7踝(3型,16.3%);ATFL单束者中的1型占5/12,双束和三束者中的2型分别占67.9%(19/28)和2/3。中立位上测得双束ATFL的下束长度为(15.15±2.84)mm,短于单束ATFL长度(18.83±3.07)mm、双束ATFL的上束长度(18.98±2.16)mm以及三束ATFL的上束长度(19.65±1.72)mm和中束长度(18.25±1.52)mm,差异有统计学意义(F=7.812, P＜0.01);但与双束ATFL的平均长度(17.07±2.16)mm以及三束ATFL的平均长度(18.52±1.47)mm相比,差异无统计学意义(F=2.433, P＞0.05)。单束ATFL宽(6.91±1.21)mm,比双束和三束ATFL韧带中各分束更宽(F=12.211, P<0.01),但要明显窄于双/三束ATFL韧带总宽度(F=29.073, P＜0.01)。所有标本CFL均呈单束,其长、宽、厚分别为(26.98±2.41)mm、(5.03±0.89)mm、(2.33±0.50)mm,不同ATFL分型中的CFL长、宽、厚差异均无统计学意义(F=0.584、0.248、1.249, P值均＞0.05)。LTCL存在于46.5%(20/43)的踝关节标本中(均为单束),止点部位直接或以薄层纤维组织黏附于ATFL或(和)CFL,LTCL长(25.99±1.86)mm、宽(4.26±0.47)mm。结论国人踝关节ATFL以双束纤维组成为主,其次为单束,再次为三束。ATFL和CFL的基本参数和腓骨上止点关系可以为解剖修复外踝韧带提供解剖学依据。同时,临床上采用LTCL(增强)修复外踝韧带时尚需考虑该韧带的变异性。

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	周云烽
	张正政
	徐静
	初国良
	徐达政
	方健辉
	彭举华
	沈慧勇
	宋斌

关键词 ：踝关节, 距腓前韧带, 跟腓韧带, 外侧距跟韧带, 应用解剖学

Abstract：Objective To explore the anatomical characteristics of the main stable structures of lateral malleolus of Chinese ankle specimens and to provide anatomical basis for diagnosis and treatment, especially the surgical intervention of ankle sprain-related diseases.Methods A total of 43 adult Chinese ankle joints, including 34 males and 9 females and 20 left and 23 right ankles, were dissected in the study to observe the morphological characteristics of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and lateral talocalcaneal ligament (LTCL) and their positional relationship. Their basic parameters were measured in a neutral position of ankle joints.Results Among the dissected ankle joints, ATFL with double bundles was most common (28 specimens), accounting for 65.1%(28/43). Single-bundle and triple-bundle ATFL accounted for 27.9% (12/43) and 7% (3/43), respectively. There were 11 ankles (type1, 25.6%) showed no fibre connection of the ATFL and CFL at the fibular origin, 25 ankles (type 2, 58.1%) showed partial fibre connection, 7 ankles showed total connection (type 3, 16.3%). Among the ankles of single ATFL, type 1 accounted for 5/12, and the type 2 accounted for 67.9% (19/28) and 2/3 in ankles with double and triple bundles, respectively. The length of the inferior bundle in double-bundle ATFL was (15.15±2.84) mm at the neutral position and was significantly shorter than that of the single-bundle (18.83±3.07) mm, superior bundle in double-bundle ATFL (18.98±2.16) mm, and superior (19.65±1.72) mm and middle (18.25±1.52) mm bundles in triple-bundle ATFL (F=7.812, P＜0.01). However, no significant difference was observed compared with the average length of double-bundle (17.07±2.16) mm and triple-bundle (18.52±1.47) mm ATFL (F=2.433, P＞0.05). The width of single-bundle ATFL was (6.91±1.21) mm, which was wider than that of double- or triple-bundle ATFL (F=12.211, P＜0.01) but narrower than the whole width of double- or triple-bundle ATFL (F=29.073, P＜0.01). The CFL presented as a single bundle in all specimens, and the average length, width, and thickness were (26.98±2.41), (5.03±0.89), and (2.33±0.50) mm, respectively. There was no significant difference in length, width and thickness among different ATFL types(F=0.584, 0.248, 1.249, all P values＞0.05). LTCL was present in 46.5% (20/43) of ankle joint specimens (all were single bundle) and directly adhered to ATFL or (and) CFL or with thin fibrous tissue at their insertions. Its average length was (25.99±1.86) mm, and the average width was (4.26±0.47) mm.Conclusions ATFL in Chinese is mainly composed of two bundles of fibers, followed by single and triple bundles. The dimensional parameters of ATFL and CFL and their positional relationship on fibula can provide anatomical basis for the repair of lateral malleolus ligaments. Meanwhile, using the LTCL to (augmented) repair lateral malleolus ligament clinically should be considered as variation of this ligament.

Key words： Ankle joint Anterior talofibular ligament Calcaneofibular ligament Lateral talocalcaneal ligament Applied anatomy

收稿日期: 2020-04-30

基金资助:广东省自然科学基金(2020A1515011322、2020B1515020014);逸仙临床研究培育项目(SYS-Q-202005)

通讯作者: 宋斌,Email: songbin3@mail.sysu.edu.cn

引用本文:

周云烽, 张正政, 徐静, 初国良, 徐达政, 方健辉, 彭举华, 沈慧勇, 宋斌. 国人外踝韧带的应用解剖学观测[J]. 中华解剖与临床杂志, 2021, 26(1): 39-44.
Zhou Yunfeng, Zhang Zhengzheng, Xu Jing, Chu Guoliang, Xu Dazheng, Fang Jianhui, Peng Juhua, Shen Huiyong, Song Bin. Applied anatomy of lateral ankle ligaments in Chinese ankle joint specimens. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 39-44.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200430-00153 或 http://www.cjac.com.cn/CN/Y2021/V26/I1/39

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