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  本文選題：距下關(guān)節(jié) + 韌帶��； 參考：《河北醫(yī)科大學》2007年碩士論文

【摘要】： 目的:( 1 )觀察正常距跟骨間韌帶(interosseous talocalcaneal ligament,ITCL)前、后束的解剖學特點并分析其臨床意義。(2)研究正常距跟骨間韌帶前、后束的生物力學特性及其臨床意義。 材料和方法:(1)10%甲醛固定成年人正常尸體足標本20副,不分性別、側(cè)別,對距跟骨間韌帶前、后束的形態(tài)進行觀察。將標本離斷踝關(guān)節(jié)后,切斷距下關(guān)節(jié)后外側(cè)面的距跟外側(cè)韌帶以及內(nèi)側(cè)面的三角韌帶脛跟部、距跟內(nèi)側(cè)韌帶。經(jīng)解剖制成距骨-韌帶-跟骨標本,解剖分離跗骨竇部的結(jié)構(gòu),顯露伸肌下支持帶的三個根及距跟骨間韌帶的外側(cè)緣。沿跗骨管后緣走行方向鋸開距骨,將其后部去除即可顯露跗骨管后部結(jié)構(gòu)。分離顯露距跟骨間韌帶后束,觀察其形態(tài),并用游標卡尺(0.02mm)進行大體測量。切除后束,分離并切斷其前方的伸肌下支持帶內(nèi)側(cè)根后,顯露距跟骨間韌帶前束,觀察其形態(tài)并進行大體測量。韌帶長度為兩附著部中點之間的距離,寬度與厚度為韌帶長度中點處的測量值。(2)12側(cè)成人新鮮下肢標本,離斷踝關(guān)節(jié),剔除距下關(guān)節(jié)水平面之上及跟骨結(jié)節(jié)處的皮膚、肌肉、肌腱等軟組織,顯露出距骨內(nèi)外踝關(guān)節(jié)面及跟骨中后部,距骨及跟骨中后部均用聚甲基丙烯酸甲脂包埋處理。在本實驗中設(shè)定足的前方為0°,外側(cè)為90°,后方為180°,內(nèi)側(cè)為270°。將制好的標本固定于萬能生物力學機上,標本每旋轉(zhuǎn)30°,沿與足底平行的方向進行力學加載三次(生物力學機以5N/秒的速度向標本施加60N的壓力)。然后將其中6側(cè)標本切斷前束,另外6側(cè)切斷后束,重復前述實驗步驟。 結(jié)果:(1)距跟骨間韌帶短而粗韌,位于距跟前后關(guān)節(jié)之間的跗骨管內(nèi),在冠狀面上該韌帶與跗骨竇方向平均成45°角,其走行方向由后內(nèi)斜向前外通過跗骨管。該韌帶由前、后兩束組成。前束纖維起于跟骨溝的后部,跗骨管底壁前緣,附著于跟骨前距關(guān)節(jié)面和中距關(guān)節(jié)面后方,外側(cè)與頸韌帶相鄰,向前上外行,止于距骨頸下方,附骨管頂壁。前束相對于后束更靠近前內(nèi)方,側(cè)面觀可見其較后束更為傾斜。前束外形呈菱形或?qū)掗煑l索狀。后束纖維附著于跟骨后距關(guān)節(jié)面前方,跗骨管后外側(cè)部,行向上內(nèi)或后上內(nèi)方,止于距骨后跟關(guān)節(jié)面前方,跗骨管頂壁即距骨溝的底部。后束纖維位于關(guān)節(jié)運動軸下方,向前與伸肌下支持帶的內(nèi)側(cè)根相鄰。該韌帶與關(guān)節(jié)囊前部緊密相貼,實為關(guān)節(jié)囊局部增厚形成.后束相對于前束更靠近后外方。側(cè)面觀見該韌帶走行方向與足底平面接近垂直,部分稍偏向后。外形可呈梯形或?qū)掗煹摹癡”字形。(2)距骨位移以及距骨位移增加量的大小與實驗方向有相關(guān)性。切斷前束后,距骨位移增加量在30°、90°、120°、150°方向上的大小要明顯大于其他方向(P0.01),距骨主要是增加了向前外側(cè)的位移。而切斷后束后,距骨位移增加量在180°、300°、330°方向上的大小要明顯大于其他方向(P0.01),距骨增加的位移主要是向前內(nèi)側(cè)。 結(jié)論:(1)距跟骨間韌帶寬大肥厚,位于距下關(guān)節(jié)中部,關(guān)節(jié)運動軸下方。本實驗所觀察到的韌帶解剖學提示,距跟骨間韌帶的作用可能主要為維持關(guān)節(jié)面緊密接觸,并防止距下關(guān)節(jié)的內(nèi)、外翻活動。另外,距跟骨間韌帶后束相對于前束纖維更靠近后外方,較前束短而粗大,在限制距骨內(nèi)翻中應(yīng)該較前束更為重要。(2)距跟骨間韌帶前后、束的功能各有側(cè)重,究其解剖特點,后束的功能更重要,手術(shù)治療韌帶重建時應(yīng)以后束為主,并應(yīng)根據(jù)后束的走行進行重建。
[Abstract]:Objective: (1) to observe the anatomical characteristics of the posterior interosseous ligament (interosseous talocalcaneal ligament, ITCL) and analyze its clinical significance. (2) to study the biomechanical characteristics and clinical significance of the anterior and posterior interosseous ligaments of the calcaneus.
Materials and methods: (1) 10% formaldehyde fixed adult normal cadaver foot specimens 20 pairs, without gender, side, to the posterior interosseous ligament, the shape of the posterior fasciculus. After disconnecting the ankle joint, cut off the lateral and lateral ligaments of the outer side of the lower joint and the medial ligament of the medial side of the medial surface and the medial ligament. Bone ligament - calcaneus specimens were dissected to separate the structure of the tarsal sinus and reveal the three roots and the lateral margin of the intercalcaneal ligament under the extensor. The talus was sawed along the posterior edge of the tarsal canal and the posterior part of the tarsal canal was removed. The posterior fasciculus of the ligaments of the calcaneus was revealed, and the shape was observed and the vernier caliper (0.02) was observed. Mm) gross measurement. After the resection of the posterior fasciculus, the posterior fasciculus of the interosseous ligament was exposed and the anterior fascicles of the interosseous ligament were exposed and observed. The length of the ligament length was two between the middle points of the attachment, and the width and thickness were measured at the point of the ligament length. (2) 12 sides of adult fresh lower extremities were isolated. The ankle joint was broken and the soft tissues such as the skin, muscle, and tendon in the calcaneus nodules were removed from the lower part of the lower part of the joint. The medial and lateral malleolus and the middle posterior part of the calcaneus were revealed. The talus and the posterior part of the calcaneus were covered with polymethacrylate methyl acrylate. In this experiment, the front was 0 degrees, the lateral was 90, the rear was 180, and the medial was 27. 0 degrees. The specimen is fixed on the universal biomechanics machine. The specimen is rotated at 30 degrees, and the mechanical load is loaded along the foot parallel to the foot for three times (the pressure of 60N is applied to the specimen at the speed of 5N/ seconds). Then the 6 sides of the specimen are cut off the front bundle and the other 6 sides are cut off and the experimental steps are repeated.
Results: (1) the intercalcaneal ligaments are short and toughened, located in the tarsal canal between the anterior and posterior joints of the heel. The ligament and the tarsal sinus on the coronal plane mean an average of 45 degrees, and the direction from the posterior oblique forward is through the tarsal canal. The ligament consists of the front and the latter two. The anterior bundle fiber is the posterior part of the calcaneus groove, the front of the tarsal canal wall, attached to the front of the tarsal canal. The anterior calcaneal surface and the middle distance of the articular surface, the lateral and the cervical ligaments, go forward and go forward out of the talus neck and attached to the top wall of the canal. The anterior bundle is closer to the anterior side than the posterior bundle. The lateral view is more inclined than the posterior bundle. The anterior bundle is rhombic or broad stripe. The posterior bundle fibers attach to the posterior of the calcaneus to the front of the articular surface and tarsus. The posterior lateral part of the canal, ascending or posterior, stops at the front of the talus posterior articular surface, the top wall of the tarsal canal, the base of the talus sulcus. The posterior bundle fiber is located below the articular motor axis and adjacent to the medial root of the extension of the extensor. The ligament is closely attached to the anterior part of the joint capsule to form the local thickening of the joint capsule. The posterior bundle is relative to the anterior bundle. It is closer to the latter. The lateral view shows that the ligament is close to the foot plane and is slightly biased. The shape can be trapezoid or broad "V". (2) the amount of the talar displacement and the amount of the talus displacement is related to the experimental direction. The increase of the talar displacement is 30, 90, 120 and 150 degrees after cutting off the anterior bundle. The size of the talus is significantly greater than that in the other directions (P0.01). The talus mainly increases the displacement of the anterolateral, and the amount of the increase of the talus displacement in the direction of 180, 300, and 330 is obviously larger than that in the other directions (P0.01), and the increase of the talus is mainly the forward side.
Conclusion: (1) broad hypertrophy of the interosseous ligaments is located in the middle of the subtalar joint and under the motor axis of the joint. The anatomical indication of the ligaments in this experiment may be mainly to maintain close contact with the intercalcaneal ligament, and to prevent the internal and outward movements of the subcalcaneal joints. In addition, the posterior bundle of intercalcaneal ligaments is relative to the anterior bundle fiber. Closer to the latter, shorter and larger than the anterior bundle, it is more important to limit the talus varus. (2) before and after the interosseous ligaments, the functions of the bundles are focused on their anatomy and the function of the posterior fasciculus is more important. The posterior bundle should be the main treatment for the reconstruction of the ligaments and should be rebuilt according to the walking of the posterior bundle.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2007
【分類號】：R322

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