长屈肌外侧转移治疗合并腓骨肌腱撕裂的解剖学比较。
Anatomic comparison of lateral transfer of the long flexors for concomitant peroneal tears.
机构信息
Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA.
出版信息
Foot Ankle Int. 2013 Dec;34(12):1718-23. doi: 10.1177/1071100713503817. Epub 2013 Sep 11.
BACKGROUND
Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle.
METHODS
In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry. Each tendon was transferred into a lateral incision, passing the FDL tendon both posterior and anterior to the tibial neurovascular bundle. The tendons were individually secured to the base of the fifth metatarsal with the foot in maximal eversion and dorsiflexion. The length of donor tendon available for fixation at the fifth metatarsal was measured. After the FDL tendon transfer was secured, the posterior neurovascular bundle was examined for signs of compression.
RESULTS
Average FHL tendon diameter measured 5.1 mm; the FDL measured 4.5 mm. After passage through a bone tunnel, an additional 4.9 cm of FHL tendon remained to suture to itself; only 0.5 cm remained for the posterior and anterior FDL transfers. Transfer of the FHL did not increase muscle bulk within the retrofibular groove. Every FDL transfer posterior to the neurovascular bundle produced obvious visual compression of the tibial nerve with plantar flexion and inversion of the foot.
CONCLUSION
Use of the FHL tendon for lateral transfer consistently provided sufficient length of tendon for multiple fixation options and a stronger muscle for transfer. Fixation options for the FDL were limited due to its shorter length. Lateral transfer of the FDL tendon posterior to the neurovascular bundle caused visible compression on the tibial nerve with ankle and hindfoot range of motion.
CLINICAL RELEVANCE
This anatomic study confirmed several advantages for the use of the FHL tendon transfer in cases of concomitant peroneal tears.
背景
为治疗同时存在的、不可修复的腓骨肌腱撕裂，已经描述了将踇长屈肌腱（FHL）或趾长屈肌腱（FDL）向外侧转移。本研究评估了 FHL 和 FDL 肌腱向外侧转移在可用肌腱长度、直径和与后神经血管束的接近程度方面的解剖学优势和限制。
方法
在 9 具尸体标本中，通过 Henry 结远端的内侧入路切断 FHL 和 FDL 肌腱。每条肌腱都转移到外侧切口，使 FDL 肌腱通过胫骨神经血管束的前后。将肌腱单独固定在第五跖骨的基部，足部处于最大外旋和背屈位。测量可供固定在第五跖骨的供体肌腱的长度。固定 FDL 肌腱转移后，检查后神经血管束是否有受压迹象。
结果
FHL 肌腱的平均直径为 5.1mm；FDL 为 4.5mm。穿过骨隧道后，FHL 肌腱还有 4.9cm 可用于自身缝合；只有 0.5cm 可用于后和前 FDL 转移。FHL 的转移不会增加腓骨肌沟内的肌肉体积。每个位于神经血管束后方的 FDL 转移都会导致胫骨神经在足跖屈和内翻时明显受压。
结论
FHL 肌腱用于外侧转移始终提供足够的肌腱长度，用于多种固定选择，并提供更强的转移肌肉。由于 FDL 长度较短，其固定选择有限。FDL 肌腱向神经血管束外侧转移会导致踝关节和后足活动范围时胫骨神经明显受压。
临床意义
这项解剖学研究证实了在同时存在腓骨肌腱撕裂的情况下，使用 FHL 肌腱转移的几个优势。
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