踝关节深层胫距后韧带的解剖学和MRI研究
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摘要
目的对踝关节深层胫距后韧带(dPTTL)进行解剖学和MRI观测,为深层胫距后韧带损伤后的诊断及修复重建提供依据。方法 34例成人尸体踝关节标本,分别测量dPTTL的长度、宽度、厚度,观察其在踝关节不同体位下的松弛-紧张变化规律,另选取我院无外伤史的36例成人踝关节MRI,对dPTTL的影像学表现进行观测。结果 dPTTL的长度为(13. 6±2. 8) mm;胫骨附着点处的宽度为(8. 6±1. 2) mm、厚度为(5. 1±1. 8) mm;中间处的宽度为(10. 3±2. 8) mm、厚度为(8. 3±1. 6) mm;距骨止点处的宽度为(12. 4±2. 3) mm、厚度为(10. 8±2. 1) mm; dPTTL在踝关节跖屈位、中立位时均为松弛状态,踝关节背伸10°左右时为紧张状态,dPTTL在踝关节MRI中出现率100%,在冠状位及横断位MRI能清晰显示。结论踝关节MRI能为dPTTL的损伤提供重要的诊断及治疗依据,修复重建踝关节深层胫距后韧带时,应该参照解剖学数据,综合考虑其长宽厚以及松紧变化规律等因素,从而提高修复重建的效果。
Objective The anatomical and MRI observations of the dPTTL of the ankles were performed to provide a basis for the diagnosis and reconstruction of the dPTTL injury. Methods The length,width,thickness of dPTTLs in ankle of 34 adult cadavers were measured,relaxation-tension variation of dPTTLs were observed and measured,the MRI of adult ankle joint in 36 cases without trauma history in our hospital were selected and the imaging findings of dPTTL were observed. Results The mean length of dPTTL was( 13. 6 ± 2. 8) mm; the mean width of tibial attachment of dPTTL was( 8. 6 ± 1. 2) mm,and the mean thickness was( 5. 1 ± 1. 8) mm; the mean of the middle of dPTTL was( 10. 3 ± 2. 8) mm,and the mean thickness was( 8. 3 ± 1. 6) mm; the mean width of talus attachment of dPTTL was( 12. 4 ± 2. 3) mm,and the mean thickness was( 10. 8 ± 2. 1) mm; dPTTL was relaxed state when the ankle plantarflexion and neutral position,however,dPTTL was tension when ankle dorsiflexion about 10°. The incidence of dPTTL in the ankle joint MRI was 100%,and the dPTTL can be clearly displayed in the coronal and axial images. Conclusion Ankle joint MRI can provide important diagnostic and therapeutic basis for dPTTL injury. When repair and reconstructe dPTTL of ankle,the anatomical data should be consulted,the length,width,thickness of dPTTL and relaxation-tension variation of dPTTL were considered to improve the effect of repairment and reconstruction.
Objective The anatomical and MRI observations of the dPTTL of the ankles were performed to provide a basis for the diagnosis and reconstruction of the dPTTL injury. Methods The length,width,thickness of dPTTLs in ankle of 34 adult cadavers were measured,relaxation-tension variation of dPTTLs were observed and measured,the MRI of adult ankle joint in 36 cases without trauma history in our hospital were selected and the imaging findings of dPTTL were observed. Results The mean length of dPTTL was( 13. 6 ± 2. 8) mm; the mean width of tibial attachment of dPTTL was( 8. 6 ± 1. 2) mm,and the mean thickness was( 5. 1 ± 1. 8) mm; the mean of the middle of dPTTL was( 10. 3 ± 2. 8) mm,and the mean thickness was( 8. 3 ± 1. 6) mm; the mean width of talus attachment of dPTTL was( 12. 4 ± 2. 3) mm,and the mean thickness was( 10. 8 ± 2. 1) mm; dPTTL was relaxed state when the ankle plantarflexion and neutral position,however,dPTTL was tension when ankle dorsiflexion about 10°. The incidence of dPTTL in the ankle joint MRI was 100%,and the dPTTL can be clearly displayed in the coronal and axial images. Conclusion Ankle joint MRI can provide important diagnostic and therapeutic basis for dPTTL injury. When repair and reconstructe dPTTL of ankle,the anatomical data should be consulted,the length,width,thickness of dPTTL and relaxation-tension variation of dPTTL were considered to improve the effect of repairment and reconstruction.
引文
[1]Savage-Elliott L,Murawski CD,Smyth NA,et al. The deltoid ligament:an in-depth review of anatomy,function,and treatment strategies[J].Knee Surg Sports Traumatol Arthrosc,2013,2l(6):1316-1327. doi:10. 1007/s00167-012-2159-3.
[2]谢龙,黄东,江奕恒,等.踝关节内侧韧带的解剖结构特点及其临床意义[J]. 2015,33(3):246-248. doi:10. 13418/j. issn. 1001-165x. 2015. 03. 002.
[3]Campbell KJ,Michalski MP,Wilson KJ,et al. The ligament anatomy of the deltoid complex of the ankle:a qualitative and quantitative anatomical study[J]. J Bone Joint Surg Am,2014,96(8):e62. doi:10.2106/JBJS. M. 00870.
[4]Panchani PN,Chappell TM,Moore GD,et al. Anatomic study of the deltoid ligament of the ankle[J]. Foot Ankle Int,2014,35(9):916-921. doi:10. 11 77/1071100714535766.
[5]毛宾尧.踝内侧韧带损伤[J].中国矫形外科杂志,2016,24(4):368-371. doi:10. 3977/j. issn. 1005-8478. 2016. 04. 16.
[6]Gérard R,Unno-Veith F,Fasel J,et al. The effect of collateral ligament release on ankle dorsiflexion:an anatomical study[J]. Foot Ankle Surg,2011,17(3):193-196. doi:10. 1016/j. fas. 2010. 06. 004.
[7]高怡加,黄枫,劳永生,等.锚钉修复三角韧带后踝关节的稳定性[J].中国组织工程研究,2017,21(19):3011-3016. doi:10. 3969/j. issn. 2095-4344. 2017. 19. 010
[8]高武长,王英振.切开复位内固定踝关节骨折:联合带线锚钉修复三角韧带损伤的意义[J].中国组织工程研究,2016,20(9):1255-1260. doi:10. 3969/j. issn. 2095-434 4. 2016. 09. 006.
[9]童琦,吴作培,孙贵新.踝关节三角韧带损伤诊疗进展[J].国际骨科学杂志,2015,36(2):105-108. doi:10. 3969/j. issn. 1673-7083. 2015. 02. 006.
[10]Lui TH. Technical tips:Reconstruction of deep and superficial deltoid ligaments by peroneus longus tendon in stage 4 posterior tibial tendon dysfunction[J]. Foot and Ankle Surg,2014,20(4):295-297. doi:10. 1016/j. fas. 2014. 04. 006.
[11]Gill JB,Risko T,Raducan V,et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures[J]. J Bone Joint Surg Am,2007,89(5):994-999.doi:10. 2106/JBJS. F. 01002.
[12]李洪军,李正维,孙刚,等.三角韧带损伤的手术治疗[J].中国矫形外科杂志,2006,14(20):1548-1550. doi:10. 3969/j. issn.1005-8478. 2006. 20. 010.
[13] Boss AP,Hintermann B. Anatomical study of the medial ankle ligament complex[J]. Foot Ankle Int,2002,23(6):547-553. doi:10.1177/107110070202300612.
[14]Milner CE,Soames RW. Anatomy of the collateral ligaments of the human ankle joint[J]. Foot Ankle Int,1998,19(11):757-760.doi:10. 1177/10711007980 1901109.
[15]李洪军,李正维,孙刚,等.踝关节内侧韧带的应用解剖学研究[J].解剖与临床,2009,14(5):310-312. doi:10. 3969/j. issn.1673—7163. 2009. 05. 002.
[16]Won HJ,Won HS,Oh CS,et al. Posterior tibiotalar ligament:an anatomic study correlated with MRI[J]. Clin Anat,2014,27(5):798–803. doi:10. 1002/ca. 22302.
[17]林浩,徐世明,黄永军,等.踝三角韧带修复重建的解剖与生物力学的基础研究[J].中国临床解剖学杂志,2017,35(3):318-326. doi:10. 13418/j. issn. 1001-165 x. 2017. 03. 017.
[18]王淑丽,马信龙,徐卫国,等.外踝骨折后三角韧带损伤程度的X线与MRI比较研究[J].中华骨科杂志,2013,33(8):834-841,doi:10. 3760/cma. j. issn. 0253-2352. 2013. 08. 009.
[19]杨清雅,徐志斌,王进.高频三维超声对三角韧带断裂的诊断价值[J].中华实用诊断治疗杂志,2014,28(10):1024-1025. doi:10. 13507/j. issn. 1674-3474. 2014. 10. 035.
[20]蔡吉勇,彭正伟,魏梅,等.磁共振在平片阴性急性踝关节外伤中的诊断价值[J].局解手术学杂志,2014,23(6):620-622. doi:10. 11659/jjssx. 1672-504 2. 201 406018.
[21]华佳,顾海燕,王伟力,等.正常踝关节内、外侧韧带的解剖及其影像学表现[J].解剖学杂志,2017,30(5):609-613. doi:10.3969/j. issn. 1001-1633. 2007. 05. 024.
[22]Mengiardi B,Pfirrmann CW,Vienne P,et al. Medial collateral ligament complex of the ankle:MR appearance in asymptomatic subjects[J]. Radiology,2007,242(3):817-824. doi:10. 1148/radiol.2423060055.
[23]Jeong MS,Choi YS,Kim YJ,et al. Deltoid ligament in acute ankle injury:MR imaging analysis[J]. Skeletal Radiol,2014,43(5):655-663. doi:10. 1007/s00256-014-1842-5.
[24]Crim J,Longenecker LG. MRI and surgical findings in deltoid ligament tears[J]. AJR,2015,204(1):63-69. doi:10. 2214/AJR. 13.11702.
[25]黄耀渠,樊长姝,秦红卫,等.踝三角韧带不同构成部分急性损伤的MRI诊断[J].临床放射学杂志,2016,35(6):919-923. doi:10. 13437/j. cnki. jcr. 2016. 06. 025.
[2]谢龙,黄东,江奕恒,等.踝关节内侧韧带的解剖结构特点及其临床意义[J]. 2015,33(3):246-248. doi:10. 13418/j. issn. 1001-165x. 2015. 03. 002.
[3]Campbell KJ,Michalski MP,Wilson KJ,et al. The ligament anatomy of the deltoid complex of the ankle:a qualitative and quantitative anatomical study[J]. J Bone Joint Surg Am,2014,96(8):e62. doi:10.2106/JBJS. M. 00870.
[4]Panchani PN,Chappell TM,Moore GD,et al. Anatomic study of the deltoid ligament of the ankle[J]. Foot Ankle Int,2014,35(9):916-921. doi:10. 11 77/1071100714535766.
[5]毛宾尧.踝内侧韧带损伤[J].中国矫形外科杂志,2016,24(4):368-371. doi:10. 3977/j. issn. 1005-8478. 2016. 04. 16.
[6]Gérard R,Unno-Veith F,Fasel J,et al. The effect of collateral ligament release on ankle dorsiflexion:an anatomical study[J]. Foot Ankle Surg,2011,17(3):193-196. doi:10. 1016/j. fas. 2010. 06. 004.
[7]高怡加,黄枫,劳永生,等.锚钉修复三角韧带后踝关节的稳定性[J].中国组织工程研究,2017,21(19):3011-3016. doi:10. 3969/j. issn. 2095-4344. 2017. 19. 010
[8]高武长,王英振.切开复位内固定踝关节骨折:联合带线锚钉修复三角韧带损伤的意义[J].中国组织工程研究,2016,20(9):1255-1260. doi:10. 3969/j. issn. 2095-434 4. 2016. 09. 006.
[9]童琦,吴作培,孙贵新.踝关节三角韧带损伤诊疗进展[J].国际骨科学杂志,2015,36(2):105-108. doi:10. 3969/j. issn. 1673-7083. 2015. 02. 006.
[10]Lui TH. Technical tips:Reconstruction of deep and superficial deltoid ligaments by peroneus longus tendon in stage 4 posterior tibial tendon dysfunction[J]. Foot and Ankle Surg,2014,20(4):295-297. doi:10. 1016/j. fas. 2014. 04. 006.
[11]Gill JB,Risko T,Raducan V,et al. Comparison of manual and gravity stress radiographs for the evaluation of supination-external rotation fibular fractures[J]. J Bone Joint Surg Am,2007,89(5):994-999.doi:10. 2106/JBJS. F. 01002.
[12]李洪军,李正维,孙刚,等.三角韧带损伤的手术治疗[J].中国矫形外科杂志,2006,14(20):1548-1550. doi:10. 3969/j. issn.1005-8478. 2006. 20. 010.
[13] Boss AP,Hintermann B. Anatomical study of the medial ankle ligament complex[J]. Foot Ankle Int,2002,23(6):547-553. doi:10.1177/107110070202300612.
[14]Milner CE,Soames RW. Anatomy of the collateral ligaments of the human ankle joint[J]. Foot Ankle Int,1998,19(11):757-760.doi:10. 1177/10711007980 1901109.
[15]李洪军,李正维,孙刚,等.踝关节内侧韧带的应用解剖学研究[J].解剖与临床,2009,14(5):310-312. doi:10. 3969/j. issn.1673—7163. 2009. 05. 002.
[16]Won HJ,Won HS,Oh CS,et al. Posterior tibiotalar ligament:an anatomic study correlated with MRI[J]. Clin Anat,2014,27(5):798–803. doi:10. 1002/ca. 22302.
[17]林浩,徐世明,黄永军,等.踝三角韧带修复重建的解剖与生物力学的基础研究[J].中国临床解剖学杂志,2017,35(3):318-326. doi:10. 13418/j. issn. 1001-165 x. 2017. 03. 017.
[18]王淑丽,马信龙,徐卫国,等.外踝骨折后三角韧带损伤程度的X线与MRI比较研究[J].中华骨科杂志,2013,33(8):834-841,doi:10. 3760/cma. j. issn. 0253-2352. 2013. 08. 009.
[19]杨清雅,徐志斌,王进.高频三维超声对三角韧带断裂的诊断价值[J].中华实用诊断治疗杂志,2014,28(10):1024-1025. doi:10. 13507/j. issn. 1674-3474. 2014. 10. 035.
[20]蔡吉勇,彭正伟,魏梅,等.磁共振在平片阴性急性踝关节外伤中的诊断价值[J].局解手术学杂志,2014,23(6):620-622. doi:10. 11659/jjssx. 1672-504 2. 201 406018.
[21]华佳,顾海燕,王伟力,等.正常踝关节内、外侧韧带的解剖及其影像学表现[J].解剖学杂志,2017,30(5):609-613. doi:10.3969/j. issn. 1001-1633. 2007. 05. 024.
[22]Mengiardi B,Pfirrmann CW,Vienne P,et al. Medial collateral ligament complex of the ankle:MR appearance in asymptomatic subjects[J]. Radiology,2007,242(3):817-824. doi:10. 1148/radiol.2423060055.
[23]Jeong MS,Choi YS,Kim YJ,et al. Deltoid ligament in acute ankle injury:MR imaging analysis[J]. Skeletal Radiol,2014,43(5):655-663. doi:10. 1007/s00256-014-1842-5.
[24]Crim J,Longenecker LG. MRI and surgical findings in deltoid ligament tears[J]. AJR,2015,204(1):63-69. doi:10. 2214/AJR. 13.11702.
[25]黄耀渠,樊长姝,秦红卫,等.踝三角韧带不同构成部分急性损伤的MRI诊断[J].临床放射学杂志,2016,35(6):919-923. doi:10. 13437/j. cnki. jcr. 2016. 06. 025.