Kumai T, Benjamin M
School of Biosciences, University of Wales Cardiff, UK.
J Anat. 2003 Aug;203(2):257-62. doi: 10.1046/j.1469-7580.2003.00209.x.
The peroneal (fibularis) tendons are held in place within the malleolar groove by the superior peroneal retinaculum. If this is torn, the tendons can subluxate or dislocate. Understanding the anatomy of the region is important for treating these injuries when it becomes necessary to reconstruct the malleolar groove surgically. Serial transverse sections of the groove were cut from 10 dissecting room cadavers after routine histology processing. The structure of the malleolar groove differed significantly in its proximal and distal parts. Distally, the bone is convex and the shape of the groove is determined by a thick periosteal cushion of fibrocartilage that covers the bone surface. Proximally, the groove shape is determined by the bone itself, and the periosteum is thin and fibrous. The restriction of a periosteal fibrocartilage to the distal end suggests that it serves to adapt the shape of the malleolar groove to that of the tendons within it and thus promotes stress dissipation. Paradoxically, however, it increases the risk of damage to subluxated tendons, because these can be sliced longitudinally by a sharp ridge created from periosteal fibrocartilage when the retinaculum is torn. Our results suggest that if bone-block surgical procedures are used to reconstruct the malleolar groove, they are best restricted to its proximal part.
腓骨肌腱通过腓骨上支持带固定于外踝沟内。若该支持带撕裂，肌腱可发生半脱位或脱位。当有必要通过手术重建外踝沟时，了解该区域的解剖结构对于治疗这些损伤很重要。在常规组织学处理后，从10具解剖室尸体上切取外踝沟的系列横切面。外踝沟的结构在其近端和远端有显著差异。在远端，骨质呈凸形，沟的形状由覆盖骨表面的一层厚的纤维软骨骨膜垫决定。在近端，沟的形状由骨质本身决定，骨膜薄且呈纤维状。骨膜纤维软骨仅限于远端这一情况表明，它有助于使外踝沟的形状与其中的肌腱形状相适应，从而促进应力消散。然而，矛盾的是，它增加了半脱位肌腱受损的风险，因为当支持带撕裂时，这些肌腱可能会被骨膜纤维软骨形成的锐利嵴纵向切割。我们的结果表明，如果采用骨块手术方法重建外踝沟，最好仅限于其近端部分。
