论文部分内容阅读
目的:探讨长伸肌腱移位治疗外翻的解剖学入路及手术的要点。方法:(1)100例正常足及100例外翻足,测量长伸屈肌腱的位置;(2)对20具尸体40足解剖,观察长伸肌腱、长屈肌腱、短伸肌腱、腓浅神经、腓深神经、隐神经及周围血管走行特点,并测量上述结构与解剖标志的相对位置。结果:正常长伸肌腱的位置在踝横纹处位于胫骨前肌外侧(9.44±4.26)m m,在跖附关节中点外侧(2.00±2.22)m m,跖趾关节中点外侧(1.32±1.46)m m,止点位于末节趾骨基底中点(2.22±2.42)m m范围内,长屈肌腱在跖趾关节中点外侧(0.44±2.42)m m。在外翻的患者中,长伸肌腱在踝横纹处位于胫骨前肌外侧(9.32±3.46)m m,在跗跖关节中点外侧(3.00±2.22)m m,跖趾关节中点外侧(4.22±2.26)m m,止点位于末节趾骨基底中点(2.02±2.32)m m范围内,长屈肌腱在跖趾关节中点外侧(3.24±2.32)m m。趾背侧皮肤由隐神经、腓浅及腓深神经支配。结论:(1)正常与外翻足的比较中,伸肌腱的位置在足横纹及止点处无明显的差异,在跖附关节及跖趾关节处,外翻足的伸肌腱明显外移(P<0.05)。长屈肌腱也明显外移(P<0.05)。(2)手术中隐神经终末支易受损伤。(3)伸肌腱内移并止点重建可矫正外翻。
Objective: To discuss the key points of anatomic approach and operation in the treatment of eversion with long extensor tendon transposition. Methods: (1) 100 cases of normal feet and 100 cases of hallux valgus were measured, and the position of long flexor tendon was measured. (2) 40 feet of 20 cadaveric bodies were dissected to observe the long extensor tendon, long flexor tendon, Extensor tendon, superficial peroneal nerve, deep peroneal nerve, saphenous nerve and surrounding blood vessels, and measured the relative position of the above structures and anatomical landmarks. Results: The position of normal long extensor tendon was 9.44 ± 4.26 mm outside of anterior tibialis ankle (2.00 ± 2.22) mm in the lateral line of the ankle, and 1.32 ± 1.46 ) mm, the dead point was in the midpoint of the distal metatarsal base (2.22 ± 2.42) mm, and the long flexor tendon was outside the midpoint of the metatarsophalangeal joint (0.44 ± 2.42) mm. In patients with eversion, long extensor tendon was located outside of tibialis anterior muscle (9.32 ± 3.46) mm at the striae of ankle, 3.30 ± 2.22 mm outside midpoint of tarsometatarsal joint, 4.22 ± 2.26) mm, the dead point was in the midpoint of the distal metatarsal base (2.02 ± 2.32) mm, and the long flexor tendon was 3.30 ± 2.32 mm in the midpoint of the metatarsophalangeal joint. The dorsal skin of the toe is dominated by saphenous nerve, peroneal and peroneal nerve. CONCLUSIONS: (1) In the comparison between normal and valgus foot, the extensor tendon position has no significant difference between the foot striation and the stop point. The extensor tendon of the valgus foot obviously moves out at the plantar and metatarsophalangeal joints (P <0.05). Long flexor tendon also significantly shift (P <0.05). (2) surgery in the saphenous nerve endings vulnerable. (3) extensor tendon transfer and end point correction can correct valgus.