本文選題：距下關節(jié)　切入點：頸韌帶　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:解剖觀察正常距跟骨間韌帶(Interosseous talocalcaneal ligament,ITCL)、頸韌帶(Cervical ligament,CL)的解剖學特點,并測量其在三維空間里的走行方向,為臨床應用MRI診斷ITCL、CL損傷找出最佳的MRI定位方法。材料和方法:1.應用7例踝關節(jié)上截肢的新鮮足標本,解剖出距跟骨間韌帶前束、后束及頸韌帶,應用游標卡尺測量韌帶的長度、寬度、厚度。應用量角器測量韌帶與踝關節(jié)冠狀面、水平面的夾角。每次測量重復3次,并記錄測量的平均值。2.選擇無足踝畸形、骨折和手術史的成年志愿者7位共14足行MRI掃描。采用3.0T超導型磁共振(美國通用公司),運用相控陣正交肢體線圈(足部專用線圈),在足中立位下,行常規(guī)踝關節(jié)掃描,并以其影像面為基準面。以解剖所得的韌帶與踝關節(jié)各個平面的夾角為參考角度,行距跟骨間韌帶的前傾斜冠狀位、內傾斜矢狀位和外傾斜矢狀位掃描;頸韌帶的內傾斜矢狀位和斜冠狀位掃描。運用電子游標卡尺,5.2IMPAX軟件版本(愛克發(fā)醫(yī)療保健公司),由擁有1年的放射學醫(yī)師和2年的肌肉與骨骼學醫(yī)師的人擔任韌帶的測量任務,每根韌帶測量3次,并記錄每根韌帶的平均值,厚度和寬度由顯影層數(shù)換算,層厚1mm,間隔0mm。結果:1.距跟骨間韌帶、頸韌帶的解剖特點及測量結果1.1頸韌帶的解剖及測量結果:頸韌帶(又稱前外側距跟韌帶或距跟前韌帶)是連接距骨和跟骨的重要韌帶,起于距骨頭前下骨性隆起處,止于前跟骨結節(jié)的背面。本研究解剖發(fā)現(xiàn)頸韌帶呈單束,未見多束韌帶。解剖測量頸韌帶的平均長、寬、厚度分別為18.43±1.47mm、9.84±1.41mm、2.47±0.64mm。頸韌帶長軸走行方向與踝關節(jié)水平面的夾角為43.83±1.65°。頸韌帶在跟骨附著處由后內斜向前外走行,與踝關節(jié)的冠狀面的夾角為61.12±2.44°;頸韌帶由后外下斜向內前上的走行方向與頸韌帶跟骨附著處相垂直的冠狀面的夾角為30.29±1.80°。1.2距跟骨間韌帶的解剖及測量結果:距跟骨間韌帶是一個片狀韌帶,起于跟骨溝,止于距骨溝,其纖維向內上傾斜。韌帶大部分位于跗骨管內,小部分位于跗骨竇內側。由于跗骨管斜向前外走行,因此該韌帶的整體斜向前外方。距跟骨間韌帶由前束和后束組成。前束在冠狀面上由前外向后內走行;后束由后內斜向前外走行,前束和后束有部分交叉。前束和后束在矢狀面上由后下斜向前上。前束的平均長、寬、厚度分別為13.90±1.55mm、8.41±1.11mm、1.76±0.35mm;后束的平均長、寬、厚度分別為9.89±1.17mm、9.05±0.35、1.79±0.65mm。距跟骨間韌帶在跟骨溝附著處由后內斜向前外的走行方向與踝關節(jié)冠狀面的夾角為36.00±4.12°;前束在冠狀位上由外下斜向內上的走行方向與踝關節(jié)水平面的夾角為35.42±0.98°,后束由內下斜向外上的走行方向與踝關節(jié)水平面的夾角為85.14±3.98°。前束和后束在矢狀位上由后下斜向前上的走行,與踝關節(jié)水平面的夾角為72.57±2.76°。2.頸韌帶、距跟骨間韌帶的mri檢查路線2.1頸韌帶的mri檢查路線在足中立位下行踝關節(jié)軸位、冠狀位和矢狀位掃描,以踝關節(jié)軸位和冠狀位的影像面為基準面。首先,在mri軸位影像上設定由后內斜向前外的mri掃描定位線平行于由后內斜向前外的頸韌帶;其次,在mri冠狀位影像上由外下斜向內上的mri掃描定位線與踝關節(jié)水平面成46°的內傾;最后,在以上定位下行內傾斜矢狀面的掃描。設定mri掃描定位線平行于頸韌帶在mri軸位上的走行方向,行頸韌帶的斜冠狀位掃描。2.2距跟骨間韌帶的mri檢查路線在足中立位下行踝關節(jié)軸位、冠狀位和矢狀位掃描。以踝關節(jié)的軸位和矢狀位影像面為基準面。首先,在踝關節(jié)軸位影像上設定由后內斜向前外的mri掃描定位線與踝關節(jié)冠狀面成36°的角;其次,在踝關節(jié)矢狀位影像上設定mri掃描定位線與踝關節(jié)冠狀位成18°(距跟骨間韌帶前束和后束在斜矢狀位上由后下斜向前上的走行與踝關節(jié)的水平面的夾角為72.57±2.76°)的前傾角;最后,行前傾斜冠狀位的掃描。以所掃描的前傾斜冠狀位的影像面為基準面,在前傾斜冠狀位影像上設定mri的掃描定位線外傾5°與后束的走行方向平行。在前傾斜冠狀位影像上設定mri的掃描定位線內傾55°與前束的走行方向平行。3.頸韌帶和距跟骨間韌帶在MRI上的掃描和測量結果3.1頸韌帶:在MRI內傾斜矢狀面上測量頸韌帶厚度、長度、寬度分別為2.64±0.63mm、18.69±1.09mm、10.06±1.82mm;在MRI斜冠狀面上測量頸韌帶寬度、長度、厚度分別為9.07±1.21mm、18.07±0.96mm、2.13±0.51mm。頸韌帶在MRI內傾斜矢狀面與斜冠狀面所得的數(shù)值的差異無統(tǒng)計學意義(P0.05)與解剖測量的數(shù)值的差異無統(tǒng)計學意義(P0.05)。3.2距跟骨間韌帶:前束在MRI前傾斜冠狀面上測量的厚、長、寬度分別為1.79±0.58mm、14.56±1.60mm、7.34±1.14mm;在MRI內傾斜矢狀位上測量前束的寬、長、厚度分別為5.07±1.0mm、13.52±1.09mm、1.34±0.44mm。后束在MRI前傾斜冠狀面上測量的厚、長、寬度分別為2.00±0.55mm、9.64±1.11mm、8.76±1.33mm;在MRI外傾斜矢狀位上測量后束的寬、長、厚度分別為6.79±0.89mm、8.41±0.89mm、1.14±0.28mm。前束在MRI前傾斜冠狀面與內傾斜矢狀面上測量的數(shù)值的差異無統(tǒng)計學意義(P0.05),與解剖測量的數(shù)值的差異無統(tǒng)計學意義(P0.05)。后束在MRI前傾斜冠狀面與外傾斜矢狀面上測量的數(shù)值的差異無統(tǒng)計學意義(P0.05),與解剖測量的數(shù)值的差異無統(tǒng)計學意義(P0.05)。結論:1.距跟骨間韌帶的MRI掃描方案1.1在踝關節(jié)軸位上外前斜36°,冠狀位上前傾18°的前傾斜冠狀面顯示距跟骨間韌帶的前后束。1.2在踝關節(jié)軸位上內前斜54°,前傾斜冠狀位上內后傾55°的內傾斜矢狀位顯示距跟骨間韌帶的前束。1.3在踝關節(jié)軸位上內前斜54°,前傾斜冠狀位上外前傾5°的外傾斜矢狀位顯示距跟骨間韌帶的后束。2.頸韌帶的MRI掃描方案2.1在軸位上前內斜61°,冠狀位上前內傾46°的內傾斜矢狀面顯示頸韌帶。2.2在軸位上前外斜29°的斜冠狀面顯示頸韌帶。
[Abstract]:Objective: To observe the normal anatomy of the interosseous talocalcaneal ligament (Interosseous talocalcaneal, ligament, ITCL), (Cervical ligament, CL cervical ligament) anatomical characteristics, and its measurement in three-dimensional space in the direction of travel, for the clinical application of MRI diagnosis of ITCL, CL MRI the best way to find damage location. Materials and methods: 1. application 7 cases of ankle amputation of the fresh foot specimens, the dissection of the interosseous talocalcaneal ligament before the beam and beam after cervical ligament was measured with a vernier caliper, ligament length, width and thickness. The application of ankle ligament and protractor to measure coronal plane, horizontal plane angle. Each measurement was repeated 3 times, and record the average measurement.2. no abnormality of ankle fracture and surgical history, a total of 7 adult volunteers 14 feet underwent MRI scanning. The 3.0T superconducting magnetic resonance (General Company), using the body coil (foot orthogonal phased array coil) in the neutral position under foot, For conventional ankle scanning, and the image plane as the datum. At an angle of the ankle joint and ligament anatomy of each plane as a reference point, before the coronary ligament between the calcaneus tilt spacing, sagittal and oblique in the oblique sagittal scan; cervical ligament in oblique sagittal and oblique coronal scanning. By using electronic calipers, 5.2IMPAX software version (Agfa HealthCare company), the measurement task owned by the radiologist for 1 years and 2 years of musculoskeletal science physician who served as the ligament, ligament of each of 3 measurements, and record the average ligaments value, thickness and width by the developer the number of conversion, thickness 1mm, interval 0mm. results: 1. interosseous talocalcaneal ligament, anatomy of 1.1 cervical ligament and measurement of anatomical characteristics and measurement results of cervical ligament: cervical ligament (also known as the anterior lateral talocalcaneal ligament or distance and ligament) is talus and calcaneus connection weight In the distance to the ligaments, bones before bony hump back, ended in this study. Before the calcaneal anatomy found cervical ligament showed a single beam, no multi beam ligament. The anatomical neck ligament of the average length, width and thickness were 18.43 + 1.47mm, 9.84 + 1.41mm, 2.47 + 0.64mm. axis angle left cervical ligament the direction of ankle joint and the horizontal plane is 43.83 + 1.65 degrees. In the calcaneal attachment by cervical ligament after inclined forward walking outside, and the angle between the coronal plane of ankle joint was 61.12 + 2.44 degrees; cervical ligament after inclined inward angle by the coronal plane ahead of the walking direction and cervical ligament attachment phase of calcaneus the vertical is 30.29 + 1.80 degrees.1.2 anatomy and measurement results of the interosseous talocalcaneal ligament, interosseous talocalcaneal ligament is a ligament in the calcaneal sulcus, flake, stop at the talus ditch, the fiber inward tilt. In most of the tarsal canal ligament, a small part in the medial tarsal sinus. 璺楅綆℃枩鍚戝墠澶栬蛋琛，

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