Chinese PLA General Hospital, Beijing, China.
Foot Ankle Int. 2013 Dec;34(12):1729-36. doi: 10.1177/1071100713500653. Epub 2013 Aug 2.
The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction.
In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view.
The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint.
The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal.
The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.
距下韧带的具体解剖结构和功能特点一直存在争议，一些人认为这阻碍了临床韧带重建的进展。
在 32 例新鲜冷冻尸体足中，仔细测量和拍摄了跗骨窦下伸肌支持带（IER）和其他距下韧带的走行，并分别从跗骨窦入口和后视图进行观察。
IER 通过 3 个根插入跗骨窦和管内：外侧根、中间根和内侧根。这些根与跗骨管一起将距下空间分为 3 部分。在 IER 前方和跗骨窦内，厚颈韧带（CL）与跟骨成 45 度角。在 IER 后方和后囊内，在大多数情况下（32 个标本中的 25 个），后囊韧带（PCaL）直接位于后距跟关节面前方。在跗骨管内，IER 的扇形内侧根从外上到内下展开，骨间跟距骨间韧带（ITCL）从内上到外下走行；这两条韧带的纤维紧密融合在一起，形成一个 V 形韧带复合体。在这个复合体的前方，在某些情况下（32 个标本中的 20 个），一个短而窄的直立韧带，跗骨管韧带（TCL），位于中距跟关节的后方。
本研究结果表明，CL 是跗骨窦内的主要韧带，而 ITCL 是一条细的单束韧带，而不是位于跗骨管内的强双层韧带。相反，IER 的内侧根是跗骨管内的主要韧带结构。
这里提供的解剖描述可能为临床距下稳定性恢复提供更准确的理论基础。
