放置内踝螺钉安全区的解剖与临床研究  

Anatomic and clinic study on safe zone for the placement of medical malleolar screws

作　　者：苗卫东[1] 王明君[1] 曹湘豫[1] 张韶民[1] 张长江[1] 张翀[1] 王斌[1] 柴充[1] 

机构地区：[1]河南省平顶山煤业集团总医院骨科,河南平顶山467000

出　　处：《中国临床解剖学杂志》2008年第6期690-692,共3页Chinese Journal of Clinical Anatomy

摘　　要：目的：报道放置内踝螺钉安垒区的解剖基础及临床治疗效果。方法：在10具成人新鲜冷冻尸体内踝标本上，平行打入3枚空心螺钉，解剖观察并测量胫后肌腱与螺钉距离和胫后肌腱损伤例数。依据解剖学研究结果，手术治疗36例内踝骨折患者，按Barid-jackson评价标准，术后随访踝关节功能恢复情况。结果：解剖学研究结果显示：1区（前丘部）螺钉在全部标本上均不与胫后肌腱接触，2区（丘间沟）螺钉距胫后肌腱平均距离3mm（1～6mm），3区（后丘部）螺钉均与胫后肌腱接触，并有6个标本肌腱损伤。临床手术治疗36例，术后随访6-24个月，按Bafitbjaekson评价，优20例，良13例，优良率91．6％。结论：内踝前丘部植入螺钉是安全区，前丘部之后植入螺钉有损伤肌腱的危险。Objective： To report anatomic basis and clinic effects of safe zone for placement of medical malleolar screws. Methods： On ten freezing fresh adult cadavers, three hollow screws were parallel inserted into inner malleolus separately. After that, the injury degree of posterior tibial muscle tendon, and the distance from it to screws, were measured and analyzed. According to this result, 36 patients were treated and judged by the Barid-jackson evaluation criteria. Results： （1） Anatomic research showed that all screws didn＇t contact the posterior tibial muscle tendon in Ⅰ zone （anterior colliculi）. The average distance between screw and the posterior tibial muscle tendon was about 3mm （1-6ram） in Ⅱzone （intergroove of colliculi）. All screws contacted the posterior tibial muscle tendon in Ⅲ zone （posterior colliculi）, and tendon injury appeared in six samples. （2） After following up 6-24 months, recovery rate of talocrural joint of patients were 91.6% （excellent 20 and better 13）, according to Barid-jackson evaluation. Conclusions： The anterior colliculi of inner malleolus is a safe zone for the placement of medical malleolar screws. It is dangerous to insert the medial malleolar screw into intergroove of colliculi and posterior colliculi of inner malleolus.

关 键 词：踝关节 内踝螺钉 内固定 安全区 

分 类 号：R683.42[医药卫生—骨科学]