Anagnostakos Konstantinos, Bachelier Felix, Fürst Oliver Alexander, Kelm Jens
Orthopädische Universitätsklinik, D-66421, Homburg/Saar, Germany.
Foot Ankle Int. 2006 May;27(5):330-9. doi: 10.1177/107110070602700504.
We report three cases of anterior tibial tendon ruptures and the results of an anatomical study in regard to the tendon's insertion site and a literature review.
Three patients were referred to our hospital with anterior tibial tendon ruptures. In the anatomical study, 53 feet were dissected, looking in particular for variants of the bony insertion of the tendon.
Two patients had surgical treatment (one primary repair and one semimembranosus tendon graft) and one conservative treatment. After a mean followup of 14 weeks all patients had satisfactory outcomes. In the anatomical study, we noted three different insertion sites: in 36 feet the tendon inserted into the medial side of the cuneiform and the base of the first metatarsal bone and in 13 feet only into the medial side of the cuneiform bone. In the remaining four feet the tendon inserted into the cuneiform and the first metatarsal bone, but an additional tendon was noted taking its origin from the anterior tibial tendon near its insertion into the medial cuneiform and attaching to the proximal part of the first metatarsal.
According to literature, surgical repair is the treatment of choice for acute ruptures and for patients with high activity levels. For chronic ruptures and patients with low demands, conservative management may lead to an equally good outcome. Knowledge of the anatomy in this region may be helpful for diagnosis and for the interpretation of intraoperative findings and choosing the most appropriate surgical procedure.
我们报告三例胫前肌腱断裂病例，并阐述了关于该肌腱止点的解剖学研究结果及文献综述。
三名因胫前肌腱断裂而转诊至我院的患者。在解剖学研究中，解剖了53只足，特别观察肌腱在骨上止点的变异情况。
两名患者接受了手术治疗（一例一期修复，一例半膜肌腱移植），一名接受保守治疗。平均随访14周后，所有患者均取得满意疗效。在解剖学研究中，我们注意到三种不同的止点：36只足中，肌腱止于楔骨内侧和第一跖骨基底；13只足中，肌腱仅止于楔骨内侧。其余四只足中，肌腱止于楔骨和第一跖骨，但发现一条额外的肌腱，其起自胫前肌腱靠近其在楔骨内侧止点处，附着于第一跖骨近端。
根据文献，手术修复是急性断裂及活动水平较高患者的首选治疗方法。对于慢性断裂及需求较低的患者，保守治疗可能会取得同样良好的效果。了解该区域的解剖结构可能有助于诊断、解释术中所见并选择最合适的手术方法。
