三角韧带解剖学影像学及生物力学课件.ppt

1、第一页，共24页。三角韧带解剖学影像学及生物力学三角韧带解剖学影像学及生物力学三角韧带的解剖The Anatomy of deltoid ligament三角韧带分为两层三角韧带分为两层6 6束束，浅层浅层4 4束，深层束，深层2 2束束 浅层:胫舟韧带、胫跳跃韧带、胫跟韧带及胫距后韧带浅层 Tibionavicular ligament,Tibiospring ligament,Tibiocalcaneal ligament,Superficial posterior tibiotalar ligament.深层:胫距前韧带深层及胫距后韧带深层 Deep anterior tibiotala

2、r ligament,Deep posterior tibiotalar ligament.第二页，共24页。三角韧带的解剖T h e A n a t o my o f d e l t o i d三角韧带的解剖The Anatomy of deltoid ligament第三页，共24页。三角韧带的解剖T h e A n a t o my o f d e l t o i d三角韧带的解剖The Anatomy of deltoid ligamentABC图图1.A.胎儿踝部冠状面胎儿踝部冠状面Mallory三色法染色，三色法染色，1.内踝，内踝，2.三角韧带深层，三角韧带深层，3.三角韧带浅层

3、，三角韧带浅层，4.胫后胫后肌腱，肌腱，5.趾长屈肌腱，趾长屈肌腱，6.载距突，载距突，7.踇长屈肌腱，踇长屈肌腱，8.纤维鞘隔膜。纤维鞘隔膜。B.三角韧带浅层示意图，三角韧带浅层示意图，1.胫舟韧带胫舟韧带，2.胫弹性韧带，胫弹性韧带，3.胫跟韧带，胫跟韧带，4.胫距后韧带浅层，胫距后韧带浅层，5.跟舟上韧带弹性韧带组成局部跟舟上韧带弹性韧带组成局部6.胫后肌腱，胫后肌腱，7.跖侧跟舟韧带弹性韧带组成局部跖侧跟舟韧带弹性韧带组成局部C.三角韧带深层，三角韧带深层，1.胫距前韧带深层，胫距前韧带深层，2.胫距后韧带深层。胫距后韧带深层。第四页，共24页。三角韧带的解剖T h e A n a t

4、 o my o f d e l t o i dFig.1.Tibionavicular ligament.2.Deep anterior tibiotalar ligament(deep layer).3.Tibiospring ligament.4.Tibiocalcaneal ligament.5.Deep posterior tibiotalar ligament(deep layer).6.Superomedial calcaneonavicular ligament(component of spring ligament).7.Plantar calcaneonavicular l

5、igament(component of spring ligament).8.Navicular tuberosity.9.Medial talar process.10.Sustentaculum tali.11.Posterior tibial tendon(cut at the level of the insertion).12.Flexor hallucis longus(cut proximal and distal).13.Tibialis anterior tendon(cut at the level of insertion).14.Long plantar ligame

6、nt.15.Plantar calcaneocuboid ligament.16.Calcaneal tendon(cut at the level of insertion)三角韧带的解剖The Anatomy of deltoid ligament第五页，共24页。F i g.1.T i b i o n a v i c u l a r l i g a me n三角韧带的解剖The Anatomy of deltoid ligamentFig.3 Medial view of the anatomical dissection of the deep layer of the deltoid

7、 ligament.The superficial layer of the deltoid ligament has been resected.Its distal insertion is maintained(arrowheads).a Plantar flexion.b Dorsiflexion.1.Deep anterior tibiotalar ligament.2.Deep posterior tibiotalar ligament.3.Talar head.4.Medial talar process.5.Sustentaculum tali.6.Anterior subta

8、lar joint.7.Posterior tibialtendon(cut at the level of insertion)第六页，共24页。三角韧带的解剖T h e A n a t o my o f d e l t o i d三角韧带影像学附着点The Attachments of deltoid ligament第七页，共24页。三角韧带影像学附着点T h e A t t a c h me n t s oFigure 4.Representative lateral radiographic images of a right ankle demonstrating the site

9、s of attachment and courses of the individual bands of the(A)superficial and(B)deep deltoid:DATT,deep anterior tibiotalar ligament;DPTT,deep posterior tibiotalar ligament;SL,spring ligament;SPTT,superficial posterior tibiotalar ligament;TC,tibiocalcaneal ligament;TN,tibionavicular ligament;TS,tibios

10、pring ligament.第八页，共24页。F i g u r e 4.R e p r e s e n t a t i v e l a t e r三角韧带的附着点The Attachments of deltoid ligamentDATT,deep anterior tibiotalar ligament;DPTT,deep posterior tibiotalar ligament;SL,spring ligament;SPTT,superficial posterior tibiotalar ligament;TC,tibiocalcaneal ligament;TN,tibiona

11、vicular ligament;TS,tibiospring ligament.第九页，共24页。三角韧带的附着点T h e A t t a c h me n t s o f d e三角韧带的MRIThe MRI of deltoid ligament第十页，共24页。三角韧带的MR IT h e MR I o f d e l t o i d l i三角韧带的MRIThe MRI of deltoid ligamentMR images in 56 asymptomatic subjectsFigure 2:Anterior TTL(anterior portion of the deep

12、layer of the MCL complex)and TSL(middle portion of the superficial layer of the MCL complex)in asymptomatic 25-year-old man.第十一页，共24页。三角韧带的MR IT h e MR I o f d e l t o i d l i三角韧带的MRIThe MRI of deltoid ligamentMR images in 56 asymptomatic subjects第十二页，共24页。三角韧带的MR IT h e MR I o f d e l t o i d l i三角

13、韧带的MRIThe Attachments of deltoid ligament第十三页，共24页。三角韧带的MR IT h e A t t a c h me n t s o f d e三角韧带的MRIThe Attachments of deltoid ligament第十四页，共24页。三角韧带的MR IT h e A t t a c h me n t s o f d e三角韧带的功能The function of deltoid ligament 踝关节是人体中最为脆弱的负重关节，其稳定性至关重要。研究发现，踝关节最主要的稳定构造为内侧三角韧带而非外侧构造1-3。Close JR等4研

14、究发现当切断所有踝关节外侧韧带而保存三角韧带时，距骨移位不超过2mm；而当踝关节外侧韧带完整而深层三角前带断裂时，距骨平均移位将到达3.7mm。Boden等在切断下胫腓前、后韧带后，由远端向近端逐渐切断骨间膜至踝上15cm，结果发现在三角韧带完整时,下胫腓最大别离距离为1.4mm，而当三角韧带断裂时,下胫腓别离到达4.5mm，Boden等认为三角韧带是维持踝关节稳定性的首要因素5。第十五页，共24页。三角韧带的功能T h e f u n c t i o n o f d e l t o i 三角韧带对踝关节的稳定作用越来越受到国内外学者的重视。Rasmussen等6发现三角韧带浅层主要限制距骨外

15、移及外翻，三角韧带深层主要限制距骨的外旋。Ziai P等7通过体外生物力学研究发现在外侧副韧带损伤的情况下，三角韧带浅层阻止了踝关节继续外旋或外翻，而深层构造在稳定距下关节所起的作用较小，因此三角韧带浅层在踝关节外侧稳定中起到了重要的作用。Earll等8报道切断浅层三角韧带后，胫距关节接触面积下降43%，压力峰值增加30%，距骨外移4mm。复旦大学上海医学院马昕教授及其研究生根据尸体解剖结果提出胫舟韧带可能只是踝关节囊加强组织，三角韧带在踝关节屈伸运动过程中存在韧带束间交替工作机制。同济大学附属同济医院俞荣耀教授认为三角韧带对踝关节的稳定作用非常重要9。三角韧带的功能The function

16、of deltoid ligament第十六页，共24页。三角韧带对踝关节的稳定作用越来越受到国内外学三角韧带的功能 选择其中一篇文献复习The function of deltoid ligament第十七页，共24页。三角韧带的功能 选择其中一篇文献复习T h e f u n c t三角韧带的功能The function of deltoid ligamentThe preset torsion between tibia and calcaneus was primarily set at 30 of internal rotation on specimen in plantar fl

17、exion and hind foot inversion.T h e f i r s t s e r i e s o f m e a s u r e m e n t s w e r e p e r f o r m e d o n h e a l t h y s p e c i m e n s a n dthe following after transecting structures in following order:anterior talofibular ligament(ATFL)in combination with calcaneofibular ligament(CFL),

18、followed by anterior tibiotalar ligament and posterior tibiotalar ligament and finally tibiocalcaneal ligament(TCL).第十八页，共24页。三角韧带的功能T h e f u n c t i o n o f d e l t o i三角韧带的功能The function of deltoid ligamentThe combined lateral ATFL and CFL instability showed a decrease in the resisting torque,whi

19、ch ensures stability in ankle sprain trauma.Only a transection of TCL(superficial layer of deltoid ligament complex)with existing lateral dual-ligament instability results in a significant decrease in torque(p 0.0001).第十九页，共24页。三角韧带的功能T h e f u n c t i o n o f d e l t o iTake home messagesp 三角韧带2层6束

20、，浅4深2p X线韧带束起止点定位重要，临床使用价值大p 踝关节最主要的稳定构造为内侧三角韧带第二十页，共24页。T a k e h o me me s s a g e s 三角韧带2 层6 束，浅4 References 1 Schuberth JM,Collman DR,Rush SM,Ford LA.Deltoid ligament integrity in lateral malleolar fractures:a comparative analysis of arthroscopic and radiographic assessments.J Foot Ankle Surg.20

21、04;43:20-9.2 Michelson JD,Clarke HJ,Jinnah RH.The effect of loading on tibiotalar alignment in cadaver ankles.Foot Ankle.1990;10:280-4.3 Michelson JD,Waldman B.An axially loaded model of the ankle after pronation external rotation injury.Clin Orthop Relat Res.1996:285-93.4 Close JR.Some applications

22、 of the functional anatomy of the ankle joint.J Bone Joint Surg Am.1956;38-A:761-81.5 Boden SD,Labropoulos PA,McCowin P,Lestini WF,Hurwitz SR.Mechanical considerations for the syndesmosis screw.A cadaver study.J Bone Joint Surg Am.1989;71:1548-55.6 Rasmussen O.Stability of the ankle joint.Analysis o

23、f the function and traumatology of the ankle ligaments.Acta Orthop Scand Suppl.1985;211:1-75.7 Ziai P,Benca E,Skrbensky GV,Wenzel F,Auffarth A,Krpo S,et al.The role of the medial ligaments in lateral stabilization of the ankle joint:an in vitro study.Knee Surg Sports Traumatol Arthrosc.2021;23:1900-

24、6.8 Earll M,Wayne J,Brodrick C,Vokshoor A,Adelaar R.Contribution of the deltoid ligament to ankle joint contact characteristics:a cadaver study.Foot Ankle Int.1996;17:317-24.9 Yu GR,Zhang MZ,Aiyer A,Tang X,Xie M,Zeng LR,et al.Repair of the acute deltoid ligament complex rupture associated with ankle

25、 fractures:a multicenter clinical study.The Journal of foot and ankle surgery:official publication of the American College of Foot and Ankle Surgeons.2021;54:198-202.第二十一页，共24页。R e f e r e n c e s 1 S c 守 破 离第二十二页，共24页。第二十二页，共2 4 页。谢谢！第二十三页，共24页。谢谢！第二十三页，共2 4 页。NoImage内容总结三角韧带解剖学影像学及生物力学。三角韧带对踝关节的稳定作用越来越受到国内外学者的重视。Rasmussen等6发现三角韧带浅层主要限制距骨外移及外翻，三角韧带深层主要限制距骨的外旋第二十四页，共24页。内容总结三角韧带解剖学影像学及生物力学。三角韧带对踝关节的稳