Heilman A E, Braly W G, Bishop J O, Noble P C, Tullos H S
Division of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030.
Foot Ankle. 1990 Feb;10(4):224-8. doi: 10.1177/107110079001000407.
Subtalar instability has been recognized as a cause of ankle symptoms. The purpose of this anatomic study is to determine the ligament damage required to produce subtalar instability, and to define a radiographic technique to demonstrate it. Ten fresh adult cadaver ankles were dissected. Selective sectioning of the calcaneofibular ligament, capsule, and interosseous ligaments of the subtalar joint were done. Radiographic documentation of subtalar opening was recorded, using a lateral and Brodan's view. Sectioning of the calcaneofibular ligament alone produced a 5-mm opening of the subtalar joint. When combined with sectioning of the interosseous ligament, a 7-mm opening was produced. This was reproduced with a plantar flexion-supination load to the foot. Instability of the ankle joint (talar tilting) was produced only when loading caused additional tearing of the anterior talofibular ligament. This study suggests that surgical repairs to correct lateral ankle instability should include repair or substitution of the calcaneofibular ligament if subtalar instability is a consideration.
距下关节不稳定已被确认为踝关节症状的一个原因。本解剖学研究的目的是确定产生距下关节不稳定所需的韧带损伤，并定义一种影像学技术来显示这种不稳定。对10个新鲜成人尸体踝关节进行了解剖。对距下关节的跟腓韧带、关节囊和骨间韧带进行了选择性切断。使用侧位和布罗丹位视图记录距下关节开口的影像学资料。单独切断跟腓韧带会使距下关节出现5毫米的开口。当与骨间韧带切断相结合时，会产生7毫米的开口。这在对足部施加跖屈-旋后负荷时得以重现。仅当负荷导致距腓前韧带额外撕裂时才会产生踝关节不稳定（距骨倾斜）。本研究表明，如果考虑到距下关节不稳定，纠正外侧踝关节不稳定的手术修复应包括修复或替代跟腓韧带。
