本文關(guān)鍵詞： 跖板 跖趾關(guān)節(jié) 足趾移植 解剖　出處：《青島大學(xué)》2007年碩士論文　論文類型：學(xué)位論文

【摘要】： 目的：通過(guò)對(duì)人體第二跖趾關(guān)節(jié)在跖板前移前、后活動(dòng)范圍的測(cè)定，研究了解跖趾關(guān)節(jié)過(guò)伸畸形的原因及與跖板的關(guān)系，采用跖板前移消除跖趾關(guān)節(jié)過(guò)伸畸形，并觀測(cè)跖板前移的距離及張力與組織學(xué)改變，為臨床提供理論依據(jù)。 方法：1．冷凍截肢足標(biāo)本21只，解剖第二趾系列。觀測(cè)從足部分離前、后跖趾關(guān)節(jié)的活動(dòng)范圍，測(cè)量跖板的長(zhǎng)度、寬度和厚度，測(cè)量跖板前移消除跖趾關(guān)節(jié)過(guò)伸畸形后跖趾關(guān)節(jié)的活動(dòng)范圍及跖板的張力與前移的距離，觀察跖板前移前、后在相同負(fù)荷(2N)下跖趾關(guān)節(jié)背伸角度的變化。 2．成年健康雞10只，取術(shù)足第二趾將跖板前移固定，石膏外固定6周，術(shù)后第10周取雙足第二趾跖板，進(jìn)行組織學(xué)觀察，了解跖板前移固定后其組織學(xué)改變。 結(jié)果：1．從足部分離前第二跖趾關(guān)節(jié)的被動(dòng)活動(dòng)范圍是背伸62.75±4.74~0，屈曲38.61±2.45~0分離后跖趾關(guān)節(jié)的背伸角度增加15.88±4.51~0，達(dá)78.63±4.49~0，屈曲角度增加3.28±3.80~0，達(dá)41.89±3.59~0，與分離前比較差異均有統(tǒng)計(jì)學(xué)意義(P＜0.05)。第二趾跖板長(zhǎng)度為19.16±1.63mm，寬度為7.73±0.73mm～11.59±0.93mm，厚度為1.88±0.27mm～4.71±0.28mm。 2．跖板前移后跖趾關(guān)節(jié)的背伸角度減少62.28±3.620，達(dá)16.35±2.650，與前移前比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.01)，屈曲角度為41.33±2.61~0，與前移前比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。 3．跖趾關(guān)節(jié)屈曲200時(shí)跖板張力為217.5±18.3g，跖板前移距離為3.53±0.40mm；跖板前移固定于骨膜前、后在趾端施加2N力時(shí)，跖趾關(guān)節(jié)的背伸角度分別為54.15±3.500和5.61±1.13~0，背伸角度減小48.55±3.70~0，二者比較差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。 4．鏡下可見(jiàn)膠原纖維沿跖板縱軸走形，間隔一定距離有斜形散射，可見(jiàn)分散存在的成纖維細(xì)胞，術(shù)后十周膠原纖維與成纖維細(xì)胞排列均正常，未見(jiàn)炎性細(xì)胞，證明跖板前移固定后沒(méi)有明顯的組織學(xué)改變。 結(jié)論：第二二跖趾關(guān)節(jié)有過(guò)伸畸形的解剖特點(diǎn)，采用跖板前移可消除跖趾關(guān)節(jié)過(guò)伸畸形。前移后跖趾關(guān)節(jié)的被動(dòng)活動(dòng)范圍是背伸16.35±2.65~0，屈曲41.3±2.61~0，當(dāng)維持跖趾關(guān)節(jié)屈曲20~0時(shí)，，跖板前移距離為3.53±0.40mm，跖板張力為217.5±18.3g，跖板前移后其組織學(xué)無(wú)明顯改變。
[Abstract]:Objective: to study the cause of metatarsophalangeal joint hyperextension and its relationship with metatarsophalangeal joint by measuring the range of movement of the second metatarsophalangeal joint before and after the metatarsophalangeal joint movement. The distance, tension and histological changes of plantar plate were observed to provide theoretical basis for clinical application. Methods 1.Twenty one frozen amputee specimens were dissected into the second toe series. The range of motion of the posterior metatarsophalangeal joint was observed and the length, width and thickness of the plantar plantar plate were measured before separation from the foot. The moving range of metatarsophalangeal joint and the distance between the tension of metatarsal plate and the forward movement of metatarsophalangeal joint were measured to observe the anterior movement of metatarsophalangeal joint. The change of dorsal extension angle of the lower metatarsophalangeal joint at the same load (2 N). 2. The second toe of the second foot was removed and the plantar plate was fixed with plaster for 6 weeks, and the plantar plate of the second toe of the second foot was taken 10 weeks after operation for histological observation. To understand the histological changes of plantar plate after anterior fixation. Results 1. The range of passive movement of the second metatarsophalangeal joint before separation from the foot was 62.75 鹵4.74. The dorsal extension angle of the metatarsophalangeal joint was increased by 15.88 鹵4.51% (78.63 鹵4.490) after the flexion of 38.61 鹵2.45 0. The flexion angle increased by 3.28 鹵3.80 to 41.89 鹵3.59kW. The difference was statistically significant (P < 0.05) and the length of the second toe plantar was 19.16 鹵1.63 mm. The width was 7.73 鹵0.73 mm and the thickness was 1.88 鹵0.27 mm and 4.71 鹵0.28 mm respectively. 2. The dorsal extension angle of metatarsophalangeal joint decreased by 62.28 鹵3.620 to 16.35 鹵2.650 after the anterior plantar plate movement, and there was significant difference between the two groups (P < 0.01). The flexion angle was 41.33 鹵2.61g, and there was no significant difference between the two groups (P > 0.05). 3. The tension of plantar plate was 217.5 鹵18.3g and the distance of plantar plate forward was 3.53 鹵0.40mm when flexion of metatarsophalangeal joint was 200; The dorsal extension angle of metatarsophalangeal joint was 54.15 鹵3.500 and 5.61 鹵1.13, respectively. The back extension angle decreased by 48.55 鹵3.70g, and the difference was statistically significant (P < 0.05). 4. Under the microscope, collagen fibers were found to be conformal along the longitudinal axis of plantar plate, with oblique scattering at a certain distance between them, and scattered fibroblasts were observed. The arrangement of collagen fibers and fibroblasts was normal 10 weeks after operation. No inflammatory cells were found, which showed that there were no obvious histological changes after anterior fixation of plantar plate. Conclusion: 22th metatarsophalangeal joint has the anatomical characteristics of hyperextension deformity, and the deformity of metatarsophalangeal joint can be eliminated by using plantar plate forward movement, and the passive activity range of metatarsophalangeal joint is 16.35 鹵2.65%. When the flexion of metatarsophalangeal joint was maintained from 20 to 0:00, the forward distance of plantar plate was 3.53 鹵0.40 mm, and the tension of plantar plate was 217.5 鹵18.3g. There was no obvious change in histology after the plantar plate was moved forward.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類號(hào)】：R322

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