跟骨外侧手术入路安全范围的解剖学研究  

A safe anatomical range of the lateral calcaneus for surgical approaches

作　　者：张勇[1] 杨云峰 翁秋燕 张雁儒 陈剑明[1] Zhang Yong;Yang Yunfeng;Weng Qiuyan;Zhang Yanru;Chen Jianming(Department of Trauma Orthopedics,No.6 Hospital of Ningbo,Ningbo 315040,China;Department of Foot and Ankle Surgery,Shanghai Tongji Hospital,Shanghai 200065,China;Medical School,Ningbo University,Ningbo 315211,China)

机构地区：[1]宁波市第六医院创伤骨科,宁波315000 [2]上海同济医院足踝外科,上海200065 [3]宁波大学医学院,宁波315211

出　　处：《中华创伤骨科杂志》2023年第10期885-889,共5页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金(32060139);浙江省医药卫生项目(2021PY072);宁波市鄞州区科技计划项目(20200432)。

摘　　要：目的通过跟骨外侧解剖学重要结构研究,归纳出"跟骨外侧手术安全范围",并设计安全手术入路。方法通过15例跟骨尸体标本,在跟骨外侧以腓骨尖顶点(最低点)为原点,建立坐标系统X、Y、Z轴。在坐标第三象限(跟骨外侧主体部分)测量跟骨外侧4个重要解剖结构范围(跟腓韧带跟骨止点、腓骨肌总腱鞘、跟骨外侧动脉、跟骨外侧神经)的空间量化关系,汇总统计各结构的走向轨迹;通过以上测量汇总,将安全范围进行重合,找出最小概率损伤跟骨外侧重要结构手术入路范围。结果重要结构在坐标第三象限跟骨外侧主体部分在X、Y、Z轴上距原点的距离分别是:跟骨外侧动脉(21.40±3.38)、(18.47±3.91)、(25.06±3.45)mm,跟骨外侧神经(16.53±4.77)、(16.27±3.68)、(23.13±4.00)mm,腓骨肌总腱鞘(9.73±1.73)、(11.47±2.13)、(10.87±1.59)mm,跟腓韧带跟骨止点(22.33±2.84)mm。上述4个重要结构主要汇聚于原点O和至跟骨外缘切线的前1/3范围,在该安全范围进行手术入路设计相对较为安全,该切口位于腓骨最低点下>2.5 cm、后侧>2.1 cm的弧形范围后侧。结论根据跟骨外侧重要解剖结构测量汇聚的安全范围,在该范围设计手术入路,可减少外侧重要结构的医源性损伤。Objective To study a safe anatomical range of the lateral calcaneus for safe surgical approaches.Methods In 15 cadaveric specimens of the calcaneus,the coordinate axes X,Y,Z were established on the apex of the fibula(the lowest point)as the origin on the lateral side of the calcaneus.In the main part of the lateral calcaneus in the third quadrant of coordinates,the spatial quantification was conducted of the 4 important anatomical structures on the lateral calcaneus(calcaneofibular ligament insertion,common peroneal tendon sheath,lateral calcaneal artery and nerve).The trend trajectory of each structure was summarized.Based on the summary of above measurements,the safety ranges were coincided to find a safe anatomical range for a surgical approach that might lead to the least probability of damaging the important lateral calcaneal structures.Results The distances from the 4 important anatomical structures to the X,Y,and Z axes of the main part of the lateral calcaneus in the third quadrant are respectively:(21.40±3.38)mm,(18.47±3.91)mm,and(25.06±3.45)mm for the lateral calcaneal artery;(16.53±4.77)mm,(16.27±3.68)mm,and(23.13±4.00)mm for the lateral calcaneal nerve;(9.73±1.73)mm,(11.47±2.13)mm,and(10.87±1.59)mm for the common peroneal tendon sheath;(22.33±2.84)mm for the calcaneofibular ligament insertion.The above 4 important structures mainly converge at the origin O and the anterior 1/3 of the tangent to the outer edge of the calcaneus.In this range,a safe surgical approach can be designed that is located at>2.5 cm below the lowest point of the fibula and 2.1 cm behind the rear side of the arc range.Conclusion A safe surgical approach can be designed in the safe convergence range of important anatomical structures of the lateral calcaneus to reduce iatrogenic injury to the important structures on the lateral side of the calcaneus.

关 键 词：跟骨 解剖 手术 安全范围 

分 类 号：R687[医药卫生—骨科学] R322[医药卫生—外科学]