胫骨近端截骨滑移对胫骨近端肌肉起点的影响  

Influence of tibial distraction osteogenesis on starting point of muscle at proximal point of tibia

作　　者：王斌[1] 张姚[1] 刘晓玲 卢爱东[3] 贾松[1] 杨焕友[1] 郝睿峥[1] 赵刚[1] 

机构地区：[1]唐山市第二医院(华北理工大学附属骨科医院)手1科修复重建外科,河北063000 [2]华北理工大学心理学院 [3]华北理工大学附属开滦总医院

出　　处：《中国骨与关节损伤杂志》2015年第10期1065-1067,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的 通过对胫骨近端肌肉起点进行解剖研究,探讨胫骨近端截骨滑移对踝关节功能的影响。方法 收集新鲜成人截肢小腿标本15例（15侧）进行解剖研究。测量胫骨平台内侧缘至胫骨内踝尖端的垂直距离,胫骨结节下缘至胫骨平台内侧缘垂直距离,胫骨前肌、趾长伸肌、比目鱼肌、胫骨后肌、趾长屈肌的上、下缘距胫骨平台内侧缘距离。对自2011-11—2013-09采用单纯胫骨近端截骨滑移治疗的17例胫骨骨缺损进行回顾性分析。结果小腿标本的胫骨全长为（349.8±8.1）mm。胫骨结节下缘至胫骨平台内侧缘垂直距离（50.1±2.3）mm。胫骨前肌起点上、下缘至胫骨平台内侧缘垂直距离分别为（27.8±2.0）mm和（232.6±5.3）mm,趾长伸肌胫骨起点的上、下缘至胫骨平台内侧缘垂直距离分别为（22.5±1.3）mm和（31.6±1.9）mm,比目鱼肌胫骨起点的上、下缘至胫骨平台内侧缘垂直距离分别为（22.9±1.6）mm和（155.7±5.5）mm,胫骨后肌起点的上、下缘至胫骨平台内侧缘垂直距离分别为（32.9±1.7）mm和（200.2±8.1）mm,趾长屈肌胫骨起点的上、下缘至胫骨平台内侧缘垂直距离分别为（114.9±8.5）mm和（219.8±9.3）mm。17例胫骨骨缺损患者均获得随访10-28个月,平均16个月。根据改良ASAMI标准对术后功能进行评定：优12例,良3例,可2例。5例出现足下垂,其中2例伴有轻度内翻,1例滑移过程中出现轴向偏移。结论 胫骨近端截骨滑移会损伤小腿肌肉起点,并且伴随滑移骨段,部分肌肉起点会随之变化;骨段滑移过程中,肌肉起点牵伸导致的肌力变化、肌肉挛缩或肌肉收缩可能会导致足下垂、足内翻畸形。Objective To investigate the influence of proximal tibial osteotomy on the function of ankle joint by anatomical study on starting point of tibial proximal muscles.Methods Fifteen fresh amputated adult legs were collected to conduct anatomy study.The vertical length of the inner margin of tibial to the tibial inner malleolus tip and the inferior margin of tubercle of tibia were measured.The vertical length from starting points of the proximal tibia muscles（superior margin and inferior margin of tibialis anterior,extensor digitorum longus,soleus,tibialis posterior and flexor digitorum longus） to the medial margin of the tibial plateau were measured.Seventeen proximal tibial distraction osteotomy cases in our department from Nov.2011 to Sept.2013 were retrospectively analyzed.Results The overall length of tibia of the leg sample was（349.8±8.1）mm.The vertical distances from the upper and lower edge of tibialis anterior starting point to the inner margin of tibial plateau were（27.8±2.0）mm and（232.6±5.3）mm respectively.The vertical distances from the upper and lower edge of the extensor digitorum longus part of the starting point from tibia to the inner margin of tibial plateau were（22.5 ±1.3）mm and（31.6±1.9）mm respectively.The vertical distances from the upper and lower edge of the soleus part of the starting point from tibia to the inner medial margin of tibial plateau were（22.9±1.6）mm and（155.7±5.5）mm respectively.The vertical distances from the upper and lower edge of the tibialis posterior part of the starting point from tibia to the inner margin of tibial plateau were（32.9±1.7）mm and（200.2±8.1）mm respectively.The vertical distances from the upper and lower edge of flexor digitorum longus starting point to the inner margin of tibial plateau were（114.9±8.5）mm and（219.8±9.3）mm respectively.All the 17 patients of tibial defect were followed up for 16 months in average（10-28 months）.Patients were assessed according to improved assessment standards ASAMI.F

关 键 词：胫骨骨缺损 胫骨近端 截骨滑移 肌肉 解剖 足部畸形 

分 类 号：R687.3[医药卫生—骨科学]