长伸肌腱移位治疗外翻的应用解剖学  

The applied anatomy of hallux valgus(HV) deformity treated with extensor hallucis longus tendon shifting

作　　者：张奉琪[1] 张英泽[1] 潘进社[1] 宋朝晖[1] 韩久卉[1] 吴昊天[1] 赵立力[1] 姚双权[1] 

机构地区：[1]河北医科大学第三医院足踝外科,石家庄050051

出　　处：《中国临床解剖学杂志》2007年第1期39-42,共4页Chinese Journal of Clinical Anatomy

摘　　要：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 anatomic points of hallux valgus （HV） deformity treated with extensor hallucis longus tendon shifting. Methods：The position of extensor hallucis longus on 100 normal feet and 100 HV feet from living bodies were investigated and measured. 40 cadaveric feet were dissected and observed the characteristics of extensor hallucis longus, flexor hallucis longus, flexor hallucis brevis, superficial and deep peroneal nerve, saphenous nerve and adjacent blood vessels, as well their relative positions. Results：For normal living body, extensor hallucis longus was about （44±4.26）mm lateral to tibialis anterior muscle at the transverse striation of ankle, （2.00±2.22）mm lateral to the middle point of tarsometatarsal joint, （ 1.32±1.46）mm lateral to the middle point of metatarsophalangeal joint, and it inserted into the center of the base of distal phalanx with the range of （2.22±2.42） mm. Flexor pollicis longus muscle tendon was about （0.44±2.42）mm lateral to the center ofmetatarsophalangeal joint. For cases of HV, extensor hallucis longus was about （9.32±3.46）mm lateral to tibialis anterior muscle at ankle transverse striation, （3.00±2.22）mm lateral to the center of tarsometatarsal joint, （4.22±2.26）mm lateral to the center of metatarsophalangeal joint, and inserted into the centre of the base of distal phalanx with the range of （2.02±2.32）mm. The flexor hallucis longus was about （3.24±2.32） mm lateral to the center of metatarsophalangeal joint. Dorsal skin of big toe was innervated by saphenous nerve, superficial and deep fibular nerve. Conclusions： Comparing with normal foot, extensor hallucis longus tendon ofpes valgus displaced laterally, as well flexor hallucis longus tendon. Distal branches of saphenous nerve easy to be injury during the operation, and it is possible to correct HV deformity by extensor hallucis tendon shifting.

关 键 词：拇长伸肌腱 移位 拇外翻 应用解剖 

分 类 号：R683.3[医药卫生—骨科学]