基于MRI下胫腓联合韧带的解剖学特点及临床意义

张磊; 杨思艺; 张小红; 曹兴旺; 夏章容; 周鑫

doi:10.16098/j.issn.0529-1356.2022.05.013

PDF(4241 KB)

解剖学报 ›› 2022, Vol. 53 ›› Issue (5) : 628-632. DOI: 10.16098/j.issn.0529-1356.2022.05.013

基于MRI下胫腓联合韧带的解剖学特点及临床意义

张磊¹ 杨思艺² 张小红² 曹兴旺² 夏章容³ 周鑫^1*

作者信息 +

Anatomical characteristics and clinical significance of the syndesmosis based on MRI

ZHANG Lei¹ YANG Si-yi² ZHANG Xiao-hong² CAO Xing-wang² XIA Zhang-rong³ ZHOU Xin^1*

Author information +

文章历史 +

摘要

目的基于MRI图像探讨下胫腓联合韧带的解剖特征，为下胫腓联合韧带相关损伤提供解剖学根据。方法对2010年1月至2021年5月西南医科大学附属中医院骨伤科门诊收治的228例患者的MRI图像资料进行回顾性分析，测量下胫腓联合韧带的相关几何数据。结果下胫腓联合前韧带平均长度（9.75±3.54）mm，平均宽度（7.27±3.09）mm，平均厚度（2.50±0.93）mm，与水平面的夹角为(47.49±14.60)°；下胫腓联合后韧带平均长度（8.94±2.43）mm，平均宽度（6.70±2.80）mm，平均厚度（2.32±1.10）mm，与水平面的夹角为(40.84±13.13)°；下横韧带平均长度（9.81±3.21）mm，平均宽度（2.28±1.51）mm，与水平面的夹角为(14.59±8.02)°；下胫腓联合骨间韧带平均长度（12.92±4.77）mm，平均宽度（3.28±1.99）mm。结论探讨下胫腓联合的解剖学特征并分析其对踝关节稳定性的作用，可以为下胫腓联合损伤的临床诊断和治疗提供有效的方式和建议。

Abstract

Objective To discuss the anatomical characteristics of the syndesmotic ligament based on MRI images, and to provide anatomical basis for clinical syndesmotic ligament injury and ligament reconstruction. Methods Totally 228 cases of MRI data from diseased person enrolled in the Orthopedics and Traumatology Department of the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from January 2010 to May 2021 were retrospectively studied. Measurement of corresponding geometrical data of the ligaments in syndesmosis were analysed. Results The average length of the syndesmosis anterior ligament was (9.75±3.54) mm, the average width (7.27±3.09) mm, and the average thickness (2.50±0.93) mm. The angle with the horizontal plane was (47.49±14.60)°; The average length of the posterior syndesmosis ligament of the lower tibia and fibula was (8.94±2.43) mm, the average width was (6.70±2.80) mm, the average thickness was (2.32±1.10) mm, and the angle with the horizontal plane was (40.84±13.13)°; the average length of the inferior transverse ligament was (9.81±3.21) mm, the average width was (2.28±1.51) mm, and the angle with the horizontal plane was 14.59°±8.02°; the average length of the inferior tibiofibular syndesmosis interosseous ligament was (12.92±4.77) mm, and the average width was (3.28±1.99) mm. The anatomical data of the anterior, posterior, inferior transverse, and interosseous ligaments of the lower tibiofibular syndesmosis, male and female, were compared, and the differences were not statistically significant. Conclusion Studying the anatomical structures and characteristics of the syndesmotic ligament and analyzing the effect of the syndesmotic ligament on the stability of the ankle joint can offer effective diagnostic means or suggestions of syndesmosis injuries in the clinically diagnose and treat.

导出引用

张磊杨思艺张小红曹兴旺夏章容周鑫. 基于MRI下胫腓联合韧带的解剖学特点及临床意义[J]. 解剖学报. 2022, 53(5): 628-632 https://doi.org/10.16098/j.issn.0529-1356.2022.05.013

ZHANG Lei YANG Si-yi ZHANG Xiao-hong CAO Xing-wang XIA Zhang-rong ZHOU Xin. Anatomical characteristics and clinical significance of the syndesmosis based on MRI[J]. Acta Anatomica Sinica. 2022, 53(5): 628-632 https://doi.org/10.16098/j.issn.0529-1356.2022.05.013

中图分类号： R445.2

参考文献

［1］Fort NM, Aiyer AA, Kaplan JR, et al. Management of acute injuries of the tibiofibular syndesmosis ［J］. Eur J Orthop Surg Traumatol, 2017, 27(4): 449-459.

［2］Yammine K. The morphology and prevalence of the deltoid complex ligament of the ankle ［J］. Foot Ankle Spec, 2017, 10(1): 55-62.

［3］Mengiardi B, Pinto C, Zanetti M. Medial collateral ligament complex of the ankle: MR imaging anatomy and findings in medial instability ［J］. Semin Musculoskelet Radiol, 2016, 20(1): 91-103.

［4］Grass R, Rammelt S, Biewener A, et al. Peroneus longus ligamentoplasty for chronic instability of the distal tibiofibular syndesmosis ［J］. Foot Ankle Int, 2003, 24(5): 392-397.

［5］Liu GT, Ryan E, Gustafson E, et al. Three-dimensional computed tomographic characterization of normal anatomic morphology and variations of the distal tibiofibular syndesmosis ［J］. J Foot Ankle Surg, 2018, 57(6): 1130-1136.

［6］Wang ChL, Huang SF, Wang ZhQ, et al. Characteristics andsurgical 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.

［7］Arroyo-Hernández M, Mellado-Romero M, Páramo-Díaz P, et al. Chronic ankle instability: arthroscopic anatomical repair ［J］. Rev Esp Cir Ortop Traumatol, 2017, 61(2): 104-110.

［8］Jolman S, Robbins J, Lewis L, et al. Comparison of magnetic resonance imaging and stress radiographs in the evaluation of chronic lateral ankle instabilit ［J］. Foot Ankle Int, 2017, 38(4): 397-404.

［9］Ebraheim NA, Taser F, Shafiq Q, et al. Anatomical evaluation and clinical importance of the tibiofibular syndesmosis ligaments ［J］. Surg Radiol Anat, 2006, 28(2): 142-149.

［10］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.

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

［12］Wang L, Wang B, Xu G, et al. Biomechanical comparison of bionic, screw and endobutton fixation in the treatment of tibiofibular syndesmosis injuries ［J］. Int Orthop, 2016, 40(2): 307-314.

［13］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.

［14］Guo H, Huang W, Zeng C. Ankle fracture with a complex injury mechanism and misleading hook test result: a case report ［J］. J Foot Ankle Surg, 2020, 59(6): 1275-1278.

［15］Park YH, Yoon MA, Choi WS, et al. The predictive value of MRI in the syndesmotic instability of ankle fracture ［J］. Skelet Radiol, 2018, 47(4): 533-540.

［16］Chissell H R, Jones J. The influence of a diastasis screw on the outcome of Weber type-C ankle fractures ［J］. J Bone Joint Surg Br, 1995, 77(3): 435-438.

［17］Egol Kenneth A, Pahk Brian, Walsh Michael, et al. Outcome after unstable ankle fracture: effect of syndesmotic stabilization ［J］. J Orthop Trauma, 2010, 24(1): 7-11.

［18］Hermans John J, Beumer Annechien, de Jong Ton AW, et al. Anatomy of the distal tibiofibular syndesmosis in adults: a pictorial essay with a multimodality approach ［J］. J. Anat., 2010, 217(6): 633-645.

［19］Sagi H Claude, Shah Anjan R, Sanders Roy W. The functional consequence of syndesmotic joint malreduction at a minimum 2-year follow-up ［J］. J Orthop Trauma, 2012, 26(7): 439-443.

［20］Vilá-Rico J, S nchez-Morata E, Vacas-Sánchez E, et al. Anatomical arthroscopic graft reconstruction of the anterior tibiofibular ligament for chronic disruption of the distal syndesmosis ［J］. Arthrosc Tech, 2018, 7(2): 165-169.

［21］Vogl TJ, Hochmuth K, Diebold T, et al. Magnetic resonance imaging in the diagnosis of acute injured distal tibiofibular syndesmosis ［J］. Invest Radiol, 1997, 32(7): 401-409.

［22］Oae K, Takao M, Naito K, et al. Injury of the tibiofibular syndesmosis: value of MR imaging for diagnosis ［J］. Radiology, 2003, 227(1): 155-161.

［23］Hermans JJ, Wentink N, Beumer A, et al. Correlation between radiological assessment of acute ankle fractures and syndesmotic injury on MRI ［J］. Skeletal Radiol, 2012, 41(7): 787-801.

［24］Hermans JJ, Ginai AZ, Wentink N, et al. The additional value of an oblique image plane for MRI of the anterior and posterior distal tibiofibular syndesmosis ［J］. Skeletal Radiol, 2011, 40(1): 75-83.

［25］Yang J, Wang P, Zhang L, et al. Anatomical characteristics and clinical significance of tibiofibular connection based on preservative specimens ［J］. Acta Anatomica Sinica, 2020, 51(4):561-565. (in Chinese)

杨晋, 王萍, 张磊, 等. 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.

［26］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.