三角韌帶解剖學(xué)、影像學(xué)及生物力學(xué)課件

三角韌帶解剖學(xué)、影像學(xué)及生物力學(xué)

TheAnatomy,RadiologyandbiomechanicsofDeltoidLigament張寧醫(yī)師Tel:+86；E-mail:zhangningno@126.com三角韌帶的解剖

TheAnatomyofdeltoidligament三角韌帶分為兩層6束，淺層4束，深層2束淺層:脛舟韌帶、脛跳躍韌帶、脛跟韌帶及脛距后韌帶淺層

Tibionavicularligament,Tibiospringligament,Tibiocalcanealligament,Superficial

posteriortibiotalarligament.深層:脛距前韌帶深層及脛距后韌帶深層

Deepanteriortibiotalarligament,Deepposteriortibiotalarligament.

三角韌帶的解剖

TheAnatomyofdeltoidligamentFig.1.Tibionavicularligament.2.Deepanteriortibiotalarligament(deeplayer).3.Tibiospringligament.4.Tibiocalcanealligament.5.Deepposteriortibiotalarligament(deeplayer).6.Superomedialcalcaneonavicularligament(componentofspringligament).7.Plantarcalcaneonavicularligament(componentofspringligament).8.Naviculartuberosity.9.Medialtalarprocess.10.Sustentaculumtali.11.Posteriortibialtendon(cutattheleveloftheinsertion).12.Flexorhallucislongus(cutproximalanddistal).13.Tibialisanteriortendon(cutatthelevelofinsertion).14.Longplantarligament.15.Plantarcalcaneocuboidligament.16.Calcanealtendon(cutatthelevelofinsertion)

三角韌帶的解剖

TheAnatomyofdeltoidligament三角韌帶的解剖

TheAnatomyofdeltoidligamentFig.3Medialviewoftheanatomicaldissectionofthedeeplayerofthedeltoidligament.Thesuperficiallayerofthedeltoidligamenthasbeenresected.Itsdistalinsertionismaintained(arrowheads).aPlantarflexion.bDorsiflexion.1.Deepanteriortibiotalarligament.2.Deepposteriortibiotalarligament.3.Talarhead.4.Medialtalarprocess.5.Sustentaculumtali.6.Anteriorsubtalarjoint.7.Posteriortibialtendon(cutatthelevelofinsertion)

三角韌帶影像學(xué)（附著點(diǎn)）

TheAttachmentsofdeltoidligamentFigure4.Representativelateralradiographicimagesofarightankledemonstratingthesitesofattachmentandcoursesoftheindividualbandsofthe(A)superficialand(B)deepdeltoid:DATT,deepanteriortibiotalarligament;DPTT,deepposteriortibiotalarligament;SL,springligament;SPTT,superficialposteriortibiotalarligament;TC,tibiocalcanealligament;TN,tibionavicularligament;TS,tibiospringligament.三角韌帶的MRI

TheMRIofdeltoidligament三角韌帶的MRI

TheMRIofdeltoidligamentMRimagesin56asymptomaticsubjects

三角韌帶的MRI

TheAttachmentsofdeltoidligament三角韌帶的功能

Thefunctionofdeltoidligament

踝關(guān)節(jié)是人體中最為脆弱的負(fù)重關(guān)節(jié)，其穩(wěn)定性至關(guān)重要。研究發(fā)現(xiàn)，踝關(guān)節(jié)最主要的穩(wěn)定結(jié)構(gòu)為內(nèi)側(cè)三角韌帶而非外側(cè)結(jié)構(gòu)[1-3]。CloseJR等[4]研究發(fā)現(xiàn)當(dāng)切斷所有踝關(guān)節(jié)外側(cè)韌帶而保留三角韌帶時(shí)，距骨移位不超過(guò)2mm；而當(dāng)踝關(guān)節(jié)外側(cè)韌帶完整而深層三角前帶斷裂時(shí)，距骨平均移位將達(dá)到3.7mm。Boden等在切斷下脛腓前、后韌帶后，由遠(yuǎn)端向近端逐漸切斷骨間膜至踝上15cm，結(jié)果發(fā)現(xiàn)在三角韌帶完整時(shí),下脛腓最大分離距離為1.4mm，而當(dāng)三角韌帶斷裂時(shí),下脛腓分離達(dá)到4.5mm，Boden等認(rèn)為三角韌帶是維持踝關(guān)節(jié)穩(wěn)定性的首要因素[5]。

三角韌帶對(duì)踝關(guān)節(jié)的穩(wěn)定作用越來(lái)越受到國(guó)內(nèi)外學(xué)者的重視。Rasmussen等[6]發(fā)現(xiàn)三角韌帶淺層主要限制距骨外移及外翻，三角韌帶深層主要限制距骨的外旋。ZiaiP等[7]通過(guò)體外生物力學(xué)研究發(fā)現(xiàn)在外側(cè)副韌帶損傷的情況下，三角韌帶淺層阻止了踝關(guān)節(jié)繼續(xù)外旋或外翻，而深層結(jié)構(gòu)在穩(wěn)定距下關(guān)節(jié)所起的作用較小，因此三角韌帶淺層在踝關(guān)節(jié)外側(cè)穩(wěn)定中起到了重要的作用。Earll等[8]報(bào)道切斷淺層三角韌帶后，脛距關(guān)節(jié)接觸面積下降43%，壓力峰值增加30%，距骨外移4mm。復(fù)旦大學(xué)上海醫(yī)學(xué)院馬昕教授及其研究生根據(jù)尸體解剖結(jié)果提出脛舟韌帶可能只是踝關(guān)節(jié)囊加強(qiáng)組織，三角韌帶在踝關(guān)節(jié)屈伸運(yùn)動(dòng)過(guò)程中存在韌帶束間交替工作機(jī)制。同濟(jì)大學(xué)附屬同濟(jì)醫(yī)院俞光榮教授認(rèn)為三角韌帶對(duì)踝關(guān)節(jié)的穩(wěn)定作用非常重要[9]。三角韌帶的功能

Thefunctionofdeltoidligament三角韌帶的功能（選擇其中一篇文獻(xiàn)復(fù)習(xí)）

Thefunctionofdeltoidligament三角韌帶的功能

ThefunctionofdeltoidligamentThepresettorsionbetweentibiaandcalcaneuswasprimarilysetat30°ofinternalrotationonspecimeninplantarflexionandhindfootinversion.Thefirstseriesofmeasurementswereperformedonhealthyspecimensand

thefollowingaftertransectingstructuresinfollowingorder:anteriortalofibularligament(ATFL)incombinationwithcalcaneofibularligament(CFL),followedbyanteriortibiotalarligamentandposteriortibiotalarligamentandfinallytibiocalcanealligament(TCL).Takehomemessages三角韌帶2層6束，淺4深2X線韌帶束起止點(diǎn)定位重要，臨床使用價(jià)值大踝關(guān)節(jié)最主要的穩(wěn)定結(jié)構(gòu)為內(nèi)側(cè)三角韌帶

References

[1]SchuberthJM,CollmanDR,RushSM,FordLA.Deltoidligamentintegrityinlateralmalleolarfractures:acomparativeanalysisofarthroscopicandradiographicassessments.JFootAnkleSurg.2004;43:20-9.

[2]MichelsonJD,ClarkeHJ,JinnahRH.Theeffectofloadingontibiotalaralignmentincadaverankles.FootAnkle.1990;10:280-4.

[3]MichelsonJD,WaldmanB.Anaxiallyloadedmodeloftheankleafterpronationexternalrotationinjury.ClinOrthopRelatRes.1996:285-93.

[4]CloseJR.Someapplicationsofthefunctionalanatomyoftheanklejoint.JBoneJointSurgAm.1956;38-A:761-81.

[5]BodenSD,LabropoulosPA,McCowinP,LestiniWF,HurwitzSR.Mechanicalconsiderationsforthesyndesmosisscrew.Acadaverstudy.JBoneJointSurgAm.1989;71:1548-55.

[6]RasmussenO.Stabilityoftheanklejoint.Analysisofthefunctionandtraumatologyoftheankleligaments.ActaOrthopScandSuppl.1985;211:1-75.

[7]ZiaiP,BencaE,SkrbenskyGV,WenzelF,AuffarthA,KrpoS,etal.Theroleofthemedialligamentsinlateralstabilizationoftheanklejoint:aninvitrostudy.KneeSurgSportsTraumatolArthrosc.2015;23:1900-6.

[8]EarllM,WayneJ,BrodrickC,VokshoorA,AdelaarR.Contributionofthedeltoidligamenttoanklejointcontactcharacteristics:acadaverstudy.FootAnkleInt.1996;17:317-24.

[9]YuGR,ZhangMZ,AiyerA