基于防腐标本的胫腓连结解剖特点及临床意义

杨晋; 王萍; 张磊; 程瀚文; 罗蓓; 王俊秋; 奉琦; 贾文利

doi:10.16098/j.issn.0529-1356.2020.04.015

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解剖学报 ›› 2020, Vol. 51 ›› Issue (4) : 561-565. DOI: 10.16098/j.issn.0529-1356.2020.04.015

解剖学

基于防腐标本的胫腓连结解剖特点及临床意义

杨晋¹ 王萍² 张磊^3,4*程翰文⁵ 罗蓓⁵ 王俊秋⁶ 奉琦⁵贾文利⁵

作者信息 +

Anatomy and clinical significance of the tibiofibular syndesmosis on anticorrosive specimens#br#

YANG Jin¹ WANG Ping² ZHANG Lei^3,4* CHENG Han-wen⁵ LUO Bei⁵ WANG Jun-qiu⁶ FENG Qi⁵ JIA Wen-li⁵
#br#

Author information +

文章历史 +

摘要

目的基于防腐标本胫腓连结的解剖特点，探讨胫腓连结的临床意义。方法选取西南医科大学的51份胫腓连结防腐标本，通过对标本进行解剖，观察其结构解剖特点，并测量胫腓连结相关几何数据。结果分别测量胫腓前、后、下横韧带的几何数据，用均值±标准差描述，包括：胫腓前韧带近端长度、远端长度、宽度分别为（8.53±0.69、19.06±1.34、15.99±1.44）mm；胫腓后韧带近端长度、远端长度、宽度分别为（9.34±0.63、16.92±1.76、14.36±0.89）mm；胫腓横韧带近端长度、远端长度、宽度分别为（18.42±2.48、21.93±2.59、4.56±0.17）mm；胫腓前韧带与冠状面夹角、与水平面夹角分别为（20.49±4.86、42.20±3.42）°；胫腓后韧带与冠状面夹角、与水平面夹角分别为（13.2±2.06、40.92±3.13）°；胫腓横韧带与冠状面夹角、与水平面夹角分别为（13.45±1.57、32.73±3.70）°；数据分析显示，胫腓前、后、横韧带在男女之间差异存在统计学意义，而在左右足之间差异无统计学意义。结论胫腓连结对踝关节的稳定性具有重要意义，其解剖结构对临床治疗有重要指导意义。

Abstract

Objective To research the clinical significance of the tibiofibular syndesmosis based on the anatomical characteristics of the tibiofibular syndesmosis. Methods A total of 51 tibiofibular syndesmosis collected from Southwest Medical University were measured based on the anatomical characteristics of the lower tibia and fibula of anticorrosive specimens. Results The geometrical data of the anterior tibiofibular ligament, posterior tibiofibular ligament and transverse tibiofibular ligament were measured respectively, and mean ± standard deviation was described. Include: the length, width, thickness of the anterior tibiofibular ligament (8.53±0.69, 19.06±1.34, 15.99±1.44) mm, the length, width, thickness of the posterior tibiofibular ligament (9.34±0.63, 16.92±1.76, 14.36±0.89) mm, the length, width, thickness of the transverse tibiofibular ligament (18.42±2.48, 21.93±2.59, 4.56±0.17) mm. The angel between the anterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (20.49±4.86, 42.20±3.42)°. The angel between the posterior tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13.2±2.06, 40.92±3.13) °. The angel between the transverse tibiofibular ligament and the coronal surface and the angle of the horizontal plane were (13.45±1.57, 32.73±3.70)°. According to the data analysis, the anterior, posterior and transverse tibiofibular ligaments have statistical difference between men and women, but there is no statistical difference between left and right feet. Conclusion The tibiofibular syndesmosis is of great significance to the stability of the ankle joint and the anatomical structure has important guiding significance for clinical treatment.

导出引用

杨晋王萍张磊程翰文罗蓓王俊秋奉琦贾文利. 基于防腐标本的胫腓连结解剖特点及临床意义[J]. 解剖学报. 2020, 51(4): 561-565 https://doi.org/10.16098/j.issn.0529-1356.2020.04.015

YANG Jin WANG Ping ZHANG Lei CHENG Han-wen LUO Bei WANG Jun-qiu FENG Qi JIA Wen-li. Anatomy and clinical significance of the tibiofibular syndesmosis on anticorrosive specimens#br#[J]. Acta Anatomica Sinica. 2020, 51(4): 561-565 https://doi.org/10.16098/j.issn.0529-1356.2020.04.015

中图分类号： R323.4

参考文献

［1］ Williams BT, James EW, Jisa KA, et al. Radiographic identification of the primary structures of the ankle syndesmosis ［J］. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4): 1187-1199.

［2］ Chun KY, Choi YS, Lee SH, et al. Deltoid ligament and tibiofibular syndesmosis injury in chronic lateral ankle instability: magnetic resonance imaging evaluation at 3T and comparison with arthroscopy ［J］. Korean J Radiol, 2015, 16(5): 1096-1103.

［3］ Wang MY. Thoughts on joint injury of ankle fracture with lower tibia and fibula ［J］. Chinese Journal of Orthopaedic Trauma, 2017, 19(9): 737-738. (in Chinese)

王满宜. 关于踝关节骨折伴下胫腓联合损伤的思考［J］. 中华创伤骨科杂志, 2017, 19(9): 737-738.

［4］ Jiang WH, Dong YL, Zhang Ch, et al. Anatomy and clinical significance of the lower end connection of adult tibia and fibula［J］. Acta Anatomica Sinica, 2013, 44(2): 249-252. (in Chinese)

姜文辉, 董伊隆, 张程, 等. 成人胫腓骨下端连接的解剖及其临床意义［J］. 解剖学报, 2013, 44(2): 249-252.

［5］ Hermans JJ, Beumer A, de Jong TA. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach ［J］. J Anat, 2010, 217(6): 633-645.

［6］ Liu ZJ, Li J, Meng Zh. Anatomic investigation of the complex body of distal tibiofibular syndesmosis ［J］. Chinese Journal of Clinical Anatomy, 2011, 29(2): 162-164. (in Chinese)

刘增君, 李军, 孟臻. 下胫腓联合稳定复合体的临床解剖学研究［J］. 中国临床解剖学杂志, 2011, 29(2): 16-164.

［7］ Michelson JD. Ankle fractures resulting from rotational injuries ［J］. J Am Acad Orthop Surg, 2003, 11(6): 403-412.

［8］ Ntalos D, Rupprecht M, Grossterlinden LG, et al. Incidence and severity of malreduction of the tibiofibular syndesmosis following surgical treatement of displaced ankle fractures and impact on the function——Clinical study and MRI evaluation［J］. Injury, 2018, 49(6): 1220-1227.

［9］ Wang ChL, Huang SF, Wang ZhQ, et al. Characteristics and surgical strategies of combined separation of lower tibia and fibula based on ankle horizontal CT ［J］. Chinese Journal of Orthopaedic Trauma, 2017, 19(12): 1036-1045. (in Chinese)

王朝亮, 黄素芳, 王仲秋, 等. 基于踝关节水平位CT下胫腓联合分离的特点及手术策略［J］. 中华创伤骨科杂志, 2017, 19(12): 1036-1045.

［10］ Hunt KJ, Phisitkul P, Pirolo J. High ankle sprains and syndesmotic injuries in athletes ［J］. J Am Acad Orthop Surg, 2015, 23(11): 66-673.

［11］ Wu ZhP, Chen PT, He JSh, et al. Classification and treatment of syndesmotic injury ［J］. China Journal of Orthopaedics and Traumatology, 2018, 31(2): 190-194. (in Chinese)

吴志朋, 陈鹏涛, 何金山, 等. 下胫腓联合损伤的分型和治疗进展［J］. 中国骨伤, 2018, 31(2): 190-194.

［12］ Shoji H, Teramoto A, Sakakibara Y, et al. Kinematics and laxity of the ankle joint in anatomic and nonanatomic anterior talofibular ligament repair: a biomechanical cadaveric study ［J］. Am J Sports Med, 2019, 47(3): 667-673.

［13］ Wuest TK. Injuries to the distal lower extremity syndesmosis ［J］. J Am Acad Orthop Surg, 1997, 5(3): 172-181.

［14］ Liu Q, Lin B, Guo Z, et al. Shapes of distal tibiofibular syndesmosis are associated with risk of recurrent lateral ankle sprains ［J］. Sci Rep, 2017, 7(1): 6244.

［15］ Shi X, Han J, Witchalls J, et al. Does treatment duration of manual therapy influence functional outcomes for individuals with chronic ankle instability: a systematic review with meta-analysis ［J］? Musculoskelet Sci Pract, 2019, 40: 87-95.

［16］ Nikolopoulos CE, Tsirikos AI, Sourmelis S. The accessory anteroinferior tibiofibular ligament as a cause of talar impingement: a cadaveric study ［J］. Am J Sports Med, 2004, 32(2):389-395.

［17］ Yuen CP, Lui TH. Distal tibiofibular syndesmosis: anatomy, biomechanics, injury and management ［J］. Open Orthop J, 2017, 11: 670-677.

［18］ Zhang Ch, Zhang LCh, Jiang WH, et al. Anatomy of distal insertion of deep posterior tibiotalar ligament of human ankle ［J］. Acta Anatomica Sinica, 2013, 44(2): 245-248. (in Chinese)

张程, 张力成, 姜文辉, 等. 人踝关节深层胫距后韧带远端止点的解剖［J］. 解剖学报, 2013, 44(2): 245-248.

［19］ Sitler DF, Amendola A, Bailey CS, et al. Posterior ankle arthroscopy: an anatomic study ［J］. J Bone Joint Surg Am, 2002, 84(5): 763-769.

［20］ Javan R, Ellenbogen AL, Greek N. A prototype assembled 3D-printed phantom of the glenohumeral joint for fluoroscopic-guided shoulder arthrography ［J］. Skeletal Radiol, 2019, 48(5):791-802.

［21］ Yu B, Huang G, George JT, et al. Singleincision technique for the internal fixation of distal fractures of the tibia and fibula: a combined anatomic and clinical study ［J］. Arch Orthop Trauma Surg, 2013, 133(12): 1631-1637.