下胫腓关节的损伤机制及其稳定复合体解剖研究
The mechanism of tibiofibular joint injury and anatomical studies in its stable complex
目的 对下胫腓关节及其稳定复合体进行解剖研究，分析下胫腓关节损伤的相关机制，以期为临床治疗提供解剖学依据。 方法 收集由福尔马林固定的5例完整的成人尸体（共10侧），模拟临床下胫腓关节损伤并进行暴力试验，解剖观察下胫腓联合韧带的稳定复合体。 结果 下胫腓的稳定复合体由胫腓下联合横韧带、前韧带、后韧带和胫腓骨间韧带构成；Cotton试验中最先撕裂的是胫腓下联合前韧带，随之接连受损的是骨间膜与下胫腓骨间韧带，胫腓下联合横韧带与后韧带均保存较为完整。 结论 下胫腓关节及其稳定复合体发生损伤时，下胫腓关节会发生分离，应及早进行关节及其稳定复合体的修复重建。
Objective To do anatomical studies in the tibiofibular joint and its stable complex, and analyse the mechanismof tibiofibular joint injury, in order to provide an anatomical basis for clinical treatment. Methods 5 cases of formalin-fixed adult cadavers (10 sides) were collected, clinical tibiofibular joint injury was simulated and violence trial was carried out. tibiofibular syndesmosis ligaments stable complex were observed. Results The stable complex was constituted by the tibiofibular joint transverse ligament, the anterior ligament, posterior ligament and the ligament between tibia and fibula. in Cotton trial, the anterior ligament was firstly tore, then the interosseous membrane and the ligament between tibia and fibula were successive damaged, and the tibiofibular joint transverse ligament and the posterior ligament were comparatively complete during the outward-turn-backward rotation of the foot. Conclusion When there is injury to the tibiofibular joint and its stable complex, the tibiofibular joint separation will occur, which should be treated by repair and reconstruction of the joint and its stable complex.
[1] Pakarinen H, Flinkkil? T, Ohtonen P, et al. Intraoperative assessment of the stability of the distal tibiofibular joint in supination-external rotation injuries of the ankle: sensitivity, specificity, and reliability of two clinical tests
[J]. J Bone Joint Surg Am, 2011, 93(22): 2057-2061.
[2] Rammelt S, Schneiders W, Grass R, et al. Ligamentous injuries to the ankle joint
[J]. Z Orthop Unfall, 2011, 149(5): 45-67.
[3] Liu X, Yu G. Progress in diagnosis and treatment of distal tibiofibular syndesmosis injury
[J]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi, 2012, 26(5): 612-616.
[4] Teramoto A, Suzuki D, Kamiya T, et al. Comparison of different fixation methods of the suture-button implant for tibiofibular syndesmosis injuries
[J]. Am J Sports Med, 2011, 39(10): 2226-2232.
[5] Schepers T. Acute distal tibiofibular syndesmosis injury: a systematic review of suture-button versus syndesmotic screw repair
[J]. Int Orthop, 2012, 36(6): 1199-1206.
[6] 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.
[7] 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.
[8] Veerappa LA, Gopalakrishna C. Traumatic proximal tibiofibular dislocation with neurovascular injury
[J]. Indian J Orthop, 2012, 46(5): 585-588.
[9] Watson DJ, Weatherby BA, Womack JW. Dunking the knot in suture button fixation for distal tibiofibular syndesmosis injury: technique tip
[J]. Foot Ankle Int, 2012, 33(8): 686-688.
[10] 邹明,张焱,柏广富,等.下胫腓联合韧带损伤与体位关系的生物力学研究
[J]. 中国临床解剖学杂志, 2012, 30(4):443-446.
[11] 刘增君,李军,孟臻.下胫腓联合稳定复合体的临床解剖学研究
[J]. 中国临床解剖学杂志, 2011, 29(9):162-164.
[12] 邹明,骆宇春.下胫腓联合的应用解剖学研究进展
[J]. 中国骨与关节损伤杂志, 2012, 27(5):478-480.
[13]Grindstaff TL, Beazell JR, Sauer LD, et al. Immediate effects of a tibiofibular joint manipulation on lower extremity H-reflex measurements in individuals with chronic ankle instability
[J]. J Electromyogr Kinesiol, 2011, 21(4): 652-658.
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