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目的通过对尸体标本踝三角韧带进行解剖观测,为踝关节韧带修复重建提供解剖与生物力学基础。方法选取成人新鲜尸体足踝标本10例,观察三角韧带的组成、起止、分布,测量各组成部分的长度、宽度及厚度;并在外翻应力位下拍摄X线片,测量踝关节内侧间隙(Mcs),依次切断三角韧带浅层、深层,并重复上述测量。结果踝三角韧带均分为深、浅两层组成,当踝关节韧带处于完整状态时,踝关节在跖屈、中立及背伸位的平均内踝间隙宽度分别为(2.67±0.38)mm、(2.42±0.35)mm、(2.55±0.24)mm。当踝关节处于中立位及最大背伸位时,切断三角韧带浅层后内踝间隙与完整状态相比均无显著性差异(P>0.05),而切断三角韧带深层后内踝间隙与完整状态相比有显著性差异(P<0.05);而当踝关节处于最大跖屈位时,所有韧带破坏状态后的内踝间隙与韧带完整时相比均无显著性差异(P>0.05)。结论(1)踝三角韧带由4条韧带束组成,各韧带束精确起止点的确定是基础研究及临床解剖重建基础。(2)通过综合踝关节跖屈位、中立位及背伸位外旋应力试验结果,可更全面、准确地诊断三角韧带损伤。
Objective To anatomize and biomechanically study the ankle ligament reconstruction of the ankle by anatomical observation of the ankle-triangular ligaments of the corpse specimens. Methods Ten adult fresh cadaveric and ankle specimens were selected. The length, width and thickness of the ligaments were observed. The X-ray films were taken under the valgus stress level and the inter-ankle gap (Mcs ), Followed by cutting off the triangular ligament shallow, deep, and repeat the above measurements. Results The ankle ligament was divided into deep and shallow layers. When the ankle ligament was intact, the mean width of medial malleolus in plantar flexion, neutrality and dorsiflexion were (2.67 ± 0.38) mm and ± 0.35) mm, (2.55 ± 0.24) mm. When the ankle joint was in the neutral position and the maximum dorsiflexion position, there was no significant difference in the ankle gap between the superficial layers of the trochanteric ligament and the intact state (P> 0.05) (P <0.05). However, when the ankle joint was at the maximum plantar flexion position, there was no significant difference in the medial malleolar gap after all the ligament rupture compared with the intact ligament (P> 0.05). Conclusions (1) Ankle trochanteric ligament consists of four ligament bundles. The exact starting and ending points of each ligament bundle are the basis of basic research and clinical anatomy and reconstruction. (2) By comprehensive ankle plantar flexion, neutral position and dorsiflexion external rotation stress test results, more comprehensive and accurate diagnosis of triangular ligament injury.