第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带的基础与临床

目的　带血供第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带提供解剖学基础。 方法　在6例经防腐固定的成人下肢标本及6 例新鲜标本上观测距腓前韧带起止点及行径,第2跗跖背侧韧带的解剖形态与起止点,在新鲜标本上模拟重建手术。 结果　第2跗跖背侧韧带位置恒定,解剖层次表浅,切取方便,第2楔骨-跗跖背侧韧带-跖骨瓣的背侧韧带长度(4.1±0.4) cm,距腓韧带长度(2.4±0.5) cm。(1)第2楔骨-跗跖背侧韧带-跖骨瓣的背侧韧带具有足够的长度,可形成移植供体;(2)带血供第2楔骨-跗跖背侧韧带-跖骨瓣复合体两端分别与骨创面固定,容易成活和恢复功能;(3)临床应用12例,全部病人随访4月~2年,重建后距腓前韧带可纠正踝内翻畸形,骨瓣愈合时间为2~3个月,踝关节功能满意,无再断裂并发症。 结论　骨瓣修整后的背侧韧带重建距腓前韧带有术式简单,重建韧带结构接近正常,受区损伤小等优点;采用带血供第2楔骨-跗跖背侧韧带-跖骨瓣重建距腓前韧带具有可行性。     

大收肌腱转位重建内侧髌股韧带的应用解剖

目的 评估大收肌腱转位重建内侧髌股韧带治疗髌骨脱位的术式可行性及可能的风险,探讨转位肌腱固定方法。 方法 解剖观察30侧尸体标本的大收肌腱及内侧髌股韧带形态及其周围血管神经等毗邻关系;测量收肌结节至内侧髌股韧带股骨止点距离、收肌结节至大收肌腱移行部距离;并在尸体标本上模拟手术。 结果 大收肌腱长度（收肌结节至收肌裂孔距离）为（105±14）mm（77~129 mm）,内侧髌股韧带轴长长度为（46±6）mm（33~57 mm）,收肌结节至内侧髌股韧带股骨止点距离为（9±2）mm（6~13 mm）,收肌结节至大收肌腱移行部距离为（124±11）mm（102~144 mm）。 结论 长约55 mm的大收肌腱通过转位固定于髌骨内侧缘重建内侧髌股韧带可行,大收肌腱作为重建内侧髌股韧带的供体是一个良好的选择。     

自体髌韧带重建前交叉韧带后膝关节外侧感觉障碍的研究

目的：研究自体B-P-B中1／3组织重建ACL后膝关节外侧皮肤感觉障碍的发病原因。方法：(1)对21例临床用自体B—P—B中1／3组织重建ACL的患者随访5～6年，测量其膝关节切口外侧皮肤感觉麻木范围。(2)解剖观察成人新鲜尸体标本3具6例和附腐固定的成人尸体标本15具30例的隐神经髌下支的分布范围。结果：术后患者均不同程度的出现膝关节外侧皮肤感觉障碍；隐神经髌下支自深筋膜穿出后，在胫骨内侧髁下方发出分支，横行跨过髌韧带分布至膝外侧皮肤。结论：隐神经髌下支分布到膝外侧皮肤，用自体B-P-B中1/3组织重建ACL在取材时可致其损伤，是术后并发膝外侧皮肤感觉障碍的原因。     

关节镜下外侧支持带松解内侧髌股韧带重建治疗复发性髌股关节脱位

目的　探讨关节镜辅助下外侧支持带松解联合内侧髌股韧带（medial patellofemoral ligament,MPFL）重建手术治疗复发性髌骨脱位的临床效果。 方法　对我院2012年1月-2015年1月收治的19例复发性髌骨脱位患者,采取关节镜辅助下行外侧支持带松解、内侧髌股韧带重建联合手术。术后定期随访,记录术前和术后影像学结果、Lysholm 膝关节功能综合评分和 Kujala 髌股关节评分,观察重建韧带长度变化。 结果　19例均获随访,时间( 25.7±8. 56) 月（12~48月）,术后无髌骨再脱位及恐惧征,无髌股关节疼痛加重,X线显示Q角在正常范围,膝关节CT（屈膝45°）显示患者髌骨外侧关节面张开角从术前平均（-1.2±6.8)°（-16°~8°）提高至术后(11.2±5.1)°（5°~18°）,较术前有显著性差异（P＜0.01）。术后1年Lysholm 评分及Kujala 髌股关节评分较术前有明显改善。重建韧带长度术后即刻平均为（57.81±6.76）mm,术后1年为（58.36±6.87）mm,无明显松弛。 结论　关节镜辅助下二联手术治疗复发性髌骨脱位,能有效恢复髌股关节位置和功能,预防复发,术后1年韧带无明显松弛,疗效满意。     

踝关节外侧韧带和距下关节韧带修复重建的应用解剖

目的 :为踝关节外侧韧带和距下关节韧带损伤修复重建提供解剖学基础。方法 :在 3 2侧经防腐固定、8侧冷藏新鲜标本上解剖观测踝关节外侧韧带和距下关节韧带及小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带 ,在新鲜标本上摹拟修复术。结果 :小趾趾长伸肌腱、第 3腓骨肌腱、腓骨短肌腱、伸肌下支持带解剖位置恒定 ,与踝关节外侧韧带和距下关节韧带相毗邻 ,具有一定的长、宽、厚度 ,可形成移植供体。结论 :①陈旧性踝关节外侧韧带和距下关节韧带的损伤 ,原位修复较难 ,用肌腱转位修复是一种可行的方法 ;②可用腓骨短肌腱修复距腓前和跟腓韧带损伤 ,小趾趾长伸肌腱和第 3腓骨肌腱转位修复距下关节韧带 ,伸肌下支持带可用作加强缝合 ,术式经标本摹拟具有可行性。     

关节镜下自体骨-髌韧带-骨重建前交叉韧带效果评价

目的　评价关节镜下用自体1/3髌骨-髌韧带-骨重建前交叉韧带的技术和疗效。 方法　自2003年1月至2010年1月对35例前交叉韧带断裂患者行关节镜下自体髌骨-髌韧带-骨重建前交叉韧带术,其中男22例,女13例,年龄23.0岁（20.0 -28.0岁）,左膝关节18例,右膝17例。35例患者均为急性损伤,受伤前均为体育运动爱好者。 结果　随访1-6年,平均3.0年,采用lysholm评分标准评价膝关节功能,术前平均59.40分（45-81分）,术后平均91.80分（72-100分）,术后与术前相比有显著差异性（p<0.5）。35例患者术后均无前叉韧带再断裂,术后34例恢复受伤前运动水平,1例运动水平较受伤前降低。术后1年有2例患者在膝极度屈曲位时有轻微膝前疼痛,但对运动水平无显著影响。 结论　关节镜下自体髌骨-髌韧带-骨重建前交叉韧带是一种微创有效的手术方法,尤其对年轻、活动量大、要求早期恢复高强度运动的患者是一种较佳的选择。     

Bassett韧带的解剖学研究及其临床意义

目的　通过对Bassett韧带的精细解剖,明确其解剖特点,探讨其功能及临床意义。 方法　取10例成人完整踝关节标本,观察韧带的起止点,走行,毗邻关系,并对相应解剖参数进行精细测量(包括它们的长度、宽度和厚度)。 结果　8例踝关节标本存在Bassett韧带,起自胫骨远端前侧止于腓骨外踝前侧,形状呈四方形,走行与下胫腓前韧带平行,长17.86~18.56 mm,宽3.22~3.89 mm,厚0.67~1.47 mm。 结论　Bassett韧带是一正常韧带组织结构,通过模拟此韧带损伤机制可探讨其造成踝关节前外侧胫距撞击综合征机制。     

不同屈曲角度时内侧髌股韧带重建的有限元分析

背景：内侧髌股韧带重建是目前治疗髌骨外侧脱位最常用的方法，最终目的是将髌骨调整到正常的解剖位置，恢复髌骨轨迹，目前内侧髌股韧带重建的主要核心问题在于其股骨端固定点的选取上。目的：运用有限元方法分析膝关节不同屈曲角度时重建内侧髌股韧带对髌骨的限制作用，模拟不同股骨端固定点重建内侧髌股韧带对髌骨的限制作用，为内侧髌股韧带重建时股骨端固定点的选取提供帮助。方法：依据提取的膝关节CT与MRI数据建立包含骨骼及软组织的膝关节有限元模型，在模拟膝关节30°与60°屈曲角度时，选取不同的股骨端固定点构建内侧髌股韧带，比较不同点位时髌股关节间接触应力与接触面积，以及对髌骨横向约束力的大小。对不同屈曲角度时相同股骨端固定点所构建的内侧髌股韧带等长性进行验证，以研究各种内侧髌股韧带重建位置的效果。结果与结论：(1)建立了30°与60°屈曲角度时膝关节的三维有限元模型，构建了不同股骨端固定点的内侧髌股韧带，不同屈曲角度时相同股骨端位置构建的内侧髌股韧带具有可用的等长性；(2)对髌骨向外侧施加位移后，在横向方向上，不同股骨端固定点构建的内侧髌股韧带对髌骨产生了不同的横向约束力，在前端10 mm处时横向约束力最...     

国人外踝韧带的应用解剖学观测

目的:探讨国人踝关节外踝韧带的解剖学特征,为临床踝关节扭伤相关疾病的诊治提供解剖学依据。方法:对43侧成年国人尸体踝关节标本外踝韧带进行应用解剖观察,其中男34侧、女9侧,左踝20侧、右踝23侧。观察距腓前韧带(ATFL)、跟腓韧带(CFL)、外侧距跟韧带(LTCL)的形态学特征,以及各韧带止点的相互关系,并在中立位上...     

同种异体肌腱解剖重建修复慢性踝关节不稳

背景：同种异体肌腱解剖重建应用于踝关节修复重建的报道目前较少。 目的：分析运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳的临床疗效。 方法：运用深低温冷冻保存同种异体肌腱解剖重建修复慢性踝关节不稳26例,其中跟腓韧带和距腓前韧带同时损伤或松弛18例,距腓前韧带单独损伤或松弛8例。采用美国足踝外科协定(AOFAS)评分及Good评级评估踝关节功能,并进行患侧与健侧踝关节背伸、跖屈活动度、后足活动度比较。 结果与结论：所有患者治疗后均获得随访,随访时间9-24个月,平均15个月。所有患者均未出现复发性踝关节外侧不稳,美国足踝外科协定(AOFAS)评分：同时修复跟腓韧带和距腓前韧带组,治疗前(48.4±3.7)分,治疗后(88.2±3.8)分,治疗后较治疗前平均提高39.8分;单独修复距腓前韧带组治疗前(50.0±6.4)分,治疗后(89.5±3.4)分,治疗后较治疗前平均提高39.5分。Good评级优 19例,良 6例,可 1例,优良率 96%。患者均无严重并发症。结果提示应用深低温冷冻保存同种异体肌腱解剖重建踝关节外侧韧带治疗踝关节慢性外侧不稳,增大了腱骨接触面积,增加了骨腱愈合的概率,增强了踝关节的稳定性,其远期疗效仍待进一步评估。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

The anterior talofibular and calcaneofibular ligaments: an anatomic study

Inversion injuries of the ankle are the most common sport injuries. Extreme inversion of the ankle affects frequently lateral ankle ligaments, especially the anterior talofibular and calcaneofibular ligaments. The aim of this study is to investigate the ligaments in detail to contribute to accurate evaluation of radiological investigations and more precise surgical interventions by clarifying the anatomic structure of the ligaments by considering their functional importance. In the study, length between the attachment points and width at the midpoint of the anterior talofibular and calcaneofibular ligaments, length and width of the bands of anterior talofibular ligament, and connecting ligaments extending from the talus to calcaneus exchanging from the both ligaments were measured on the 46 ankles. In addition, angles between these ligaments and between longitudinal axis of the fibula and both ligaments were measured. Relationship between determined variables on the right and left sides was statistically analyzed. In diagnosis and treatment methods, the clinical importance of the anatomy of the lateral collateral ligaments of the ankle, especially the anterior talofibular and calcaneofibular ligaments, was frequently reported in the literature. Angular measurements benefit in determination of the ligament injury. Therefore, knowledge about normal anatomic angles between each other and angles between longitudinal axis of the fibula and both ligaments was certainly important for the correct diagnosis. Nowadays, surgical reconstructions of the ligaments are frequently used. During the surgical invention, length and width of the ligaments are necessary to determine quantity of ligament loss. Nonetheless, knowledge of ligament attachments contributes to more accurate reconstructions.     

髌韧带血供及其在重建膝交叉韧带中的意义

目的：探讨髌韧带血供的特点,为临床交叉韧带移植重建提供应用解剖学资料。方法：通过对成人和胎儿下肢标本经股动脉红色乳胶灌注并解剖观察,以及胎儿墨汁灌注组织透明和组织切片等方法,观察髌韧带的动脉来源、分布特点,并测量胎儿韧带内微血管密度。结果：髌韧带的动脉来自膝下外动脉、胫前返动脉、膝降动脉和膝下内侧动脉的分支;胎儿髌韧带不同区域微血管密度不同,以韧带中心部位密度最低。结论：髌韧带中心部为相对乏血管区,对以髌韧带为替代物行交叉韧带重建有重要的临床意义。     

髌外侧支持带的解剖观测及临床意义

目的：观察髌外侧支持带的解剖学特点，探讨其对维持正常髌骨运动轨迹的作用。方法：采用50例经福尔马林固定的成人尸膝标本，观测髌外侧支持带的形态学特点。结果：髌外侧支持带可分为浅、深两层。浅层较薄，深层包括外侧横韧带(100％)、外侧髌胫韧带(85％)和上髁髌韧带(35％)3个独立结构，其中外侧横韧带是限制髌骨内移的主要结构。结论：髌外侧支持带中外侧横韧带最为粗壮，对维持正常髌骨运动轨迹起决定性作用。     

踝关节内侧韧带的应用解剖学研究

目的：探讨踝关节内侧韧带的组成及其各部的附着、走行及毗邻关系。方法：取30例40％甲醛溶液防腐保存的正常成人尸体标本及4侧临床截肢的新鲜成人正常踝关节标本。仔细解剖出踝关节内侧韧带各组成部分的起止点及毗邻关系,然后测量各部的长、宽及厚的数值。结果：踝关节内侧副韧带由深浅两层组成。浅层包括胫舟韧带、胫韧带及胫跟韧带,其中胫韧带和胫跟韧带是恒定的;深层由胫距前、后韧带组成,其中胫距后韧带是恒定的。测量结果显示：胫舟韧带最长,（29．2±3．54）mm;胫距后韧带最宽、最厚,分别是（12．5±3．51）mm和（10．1±2．34）mm。结论：本研究为踝关节内侧韧带损伤的修复重建提供了重要的解剖学基础。     

Anatomy of lateral ankle ligaments and their relationship to bony landmarks

This study was designed to determine and describe precise anatomy of the lateral ankle ligaments and their relationship to adjacent osseous structures. This study was performed on 42 legs of 22 adult human embalmed cadavers. The lateral ankle ligaments were carefully dissected using a 2.5× surgical loupe. Mean values for the length, width and angle of the individual lateral ankle ligaments were measured. The precise location of insertion points and course of each ligament was observed and noted with ankle placed in neutral position. The anterior talofibular and calcaneofibular ligaments were coated with radio-opaque material. Radiographs were then taken in the anteroposterior, mortise and lateral projections. The anterior talofibular ligament (ATFL) was a flat, quadrilateral ligament and it made mean angle of 25° (range 5°–45°) with horizontal plane, and a mean angle of 47° (range 45°–56°) with sagittal plane. The posterior talofibular ligament was oriented in a nearly horizontal plane. Calcaneofibular ligament (CFL) was a flat oval ligament. It made a mean angle of 40° (range 30°–58°) with horizontal plane, and mean angle of 51° (range 32°–60°) with sagittal plane. The angle between CFL and ATFL was approximately 132° (range 118°–145°). These data provides important information for diagnosing injury and reconstructing lateral ankle ligaments.     

踝、距下关节外侧韧带断层与MRI图像的对照研究及临床意义

目的 :为临床MRI诊断踝、距下关节外侧韧带损伤提供断层解剖学依据。方法 :利用低温冰冻技术 ,当足呈自然放松位时 ,将踝、距下关节制成 3 .5mm厚的薄层断层标本 ,并与该区的磁共振图像相对照。结果 :距腓前韧带在轴位 ,跟腓韧带在冠状位和斜轴位 ,距腓后韧带在四个方位 ,颈韧带在冠状位和矢状位 ,距跟骨间韧带在冠状位、矢状位和斜轴位 ,伸肌下支持带浅束在冠状位和矢状位 ,中束和深束在冠状位 ,能清楚观察各韧带的形态和毗邻关系。结论 :在MRI上能清楚显示踝、距下关节外侧区的各条韧带。     

Surgical Considerations in the Treatment of Ankle Instability

OBJECTIVE: To review the surgical indications, techniques, biomechanical testing, and clinical results reported for the most common surgical techniques used to treat ankle instability. DATA SOURCES: We searched MEDLINE from 1960-2001 using the terms ankle instability, functional ankle instability, mechanical ankle instability, ankle ligament surgery, Brostr?m, Chrisman-Snook, and Evans. DATA SYNTHESIS: Although 80% to 85% of acute ankle sprains are successfully treated with a functional ankle-rehabilitation program, the remaining 15% to 20% have recurrent ankle instability and reinjury, necessitating surgical intervention. The fundamentals of the surgical approach to lateral ankle instability are based on the anatomy of the lateral ankle ligaments, the anterior talofibular ligament, and the calcaneofibular ligament. Ankle-instability surgery has been broadly divided into an anatomic repair consisting of an imbrication of the lateral ligamentous complex and an ankle-ligament reconstruction. An ankle-ligament reconstruction weaves a harvested tendon graft, most commonly the peroneus brevis, to augment the lateral ligaments of the ankle. Goals of surgery are to reestablish ankle stability and function without compromising motion and without complications. Anatomic repair and imbrication of the lateral ligament complex with the Gould modification has an 85% to 95% success rate, and the risk of associated nerve injuries is low. This approach provides increased stability by reinforcing local host tissue, preserving subtalar and talocrural motion, eliminating the comorbidity associated with tendon-graft harvest, and offering a quicker functional recovery. One concern in using the anatomic approach is the resultant strength of the repair, although the literature does not support this concern. Ankle-reconstruction procedures that sacrifice tendons are thought to provide a stronger construct, and hence, more stability. This increased stability results in loss of talocrural and subtalar range of motion, prolonging recovery and decreasing sport performance. Adjacent nerve injury is more common with ankle-ligament reconstruction. CONCLUSIONS/RECOMMENDATIONS: Based on the literature, we believe that a modified Brostr?m lateral-ligament repair should be considered the first choice for persistent ankle instability refractory to a functional ankle-rehabilitation protocol. Ankle reconstruction with tendon augmentation should be reserved for patients with generalized ligamentous laxity or long-standing ligamentous insufficiency or as a salvage procedure in a patient with a failed modified Brostr?m lateral-ligament repair.     

An initial qualitative study of dual-energy CT in the knee ligaments

OBJECTIVE: To study the clinical application of dual-energy CT (DECT) in the knee ligaments. METHODS: Twelve cases (24 knees) were scanned using dual-energy CT for the knee. Two- and three-dimensional images were used for display in all cases by means of multi-planar reformation (MPR) and volume rendering technique (VRT). All images were ranked by two radiologists according to the grade of knee ligament displayed, the definition of edge and attachment points of the knee ligament. RESULTS: The partial ligaments of 24 knees, such as the patellar ligament, fibular collateral ligament, anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were clearly displayed; the tibial collateral ligament was not satisfactorily displayed. The transversal ligaments, such as lateral patellar retinaculum and medial patellar retinaculum, and the posterior ligament, such as oblique popliteal ligament could not be shown clearly. CONCLUSION: The dual-energy CT is a new and valuable tool to qualitatively display the main ligaments of the knee.