Pretterklieber Bettina
Medical University of Vienna, Center for Anatomy and Cell Biology, Division of Anatomy, Waehringer Strasse 13, 1090, Vienna, Austria.
Ann Anat. 2017 May;211:21-32. doi: 10.1016/j.aanat.2017.01.011. Epub 2017 Feb 3.
As tendon transfer of the flexor hallucis longus (FHL) and the flexor digitorum longus (FDL) is an established procedure, exact knowledge of the formation of the chiasma plantare is of great interest. Although the quadratus plantae (QP) appears to play a major role, it has been rarely addressed in previous studies. The aim of the present study was to reinvestigate the formation of the chiasma plantare and the composition of the long flexor tendons in order to clarify the inexact and partly contradictory descriptions published from 1865 onward. The chiasma plantare and the long flexor tendons in both feet of 50 formalin-fixed specimens of body donors (25 men and women) were analyzed by gross anatomical dissection. It was composed of one (3%), two (69%) or three layers (28%) which were variably established by the tendinous and muscular fibers of the FHL, the FDL and the QP. In 61% the FHL gave one or more slips to the FDL, and in 39% there was a bidirectional interconnection between the two tendons. The slip from the FHL to the FDL largely reinforces the second (45%), or the second and third tendon (46%). Thus, the FHL is involved in the first tendon in all cases, in the second one in 97% of cases, and in the third tendon in about one half of cases (53%). In all instances, the FDL contributes to the third to fourth, in 98% the second, and in at least 39% to the first tendon. The QP reinforces the second to fourth tendon in nearly all cases, the fifth in about one half of cases, and even the first tendon in 14% of cases. In addition, the individual composition of the five long flexor tendons arising from the chiasma plantare was analyzed in detail. Special emphasis was placed on the evaluation of side and sex differences as well as individual symmetry. Furthermore, biomechanical, developmental and phylogenetic aspects were outlined. In terms of the outcome of this study, the FHL appears to be the better donor for tendon transfer to restore lost function, but harvesting the FDL seems to be more suitable to prevent long-term functional damage. The decision depends on the individual patient's needs and should be made with due care.
由于拇长屈肌（FHL）和趾长屈肌（FDL）的肌腱转移是一种既定的手术方法，因此准确了解足底交叉的形成具有重要意义。尽管跖方肌（QP）似乎起着主要作用，但在以往的研究中很少涉及。本研究的目的是重新研究足底交叉的形成和长屈肌腱的组成，以澄清自1865年以来发表的不准确且部分相互矛盾的描述。通过大体解剖分析了50具尸体供体（25名男性和女性）双脚的足底交叉和长屈肌腱。它由一层（3%）、两层（69%）或三层（28%）组成，这些层由FHL、FDL和QP的肌腱和肌肉纤维以不同方式形成。在61%的情况下，FHL向FDL发出一个或多个分支，在39%的情况下，两根肌腱之间存在双向连接。FHL至FDL的分支主要加强第二根肌腱（45%），或第二和第三根肌腱（46%）。因此，FHL在所有情况下都参与第一根肌腱，在97%的情况下参与第二根肌腱，在约一半的情况下（53%）参与第三根肌腱。在所有情况下，FDL参与第三至第四根肌腱，在98%的情况下参与第二根肌腱，在至少39%的情况下参与第一根肌腱。QP几乎在所有情况下加强第二至第四根肌腱，在约一半的情况下加强第五根肌腱，甚至在14%的情况下加强第一根肌腱。此外，还详细分析了由足底交叉产生的五条长屈肌腱的个体组成。特别强调了对侧别和性别差异以及个体对称性的评估。此外，还概述了生物力学、发育和系统发育方面。就本研究的结果而言，FHL似乎是用于肌腱转移以恢复丧失功能的更好供体，但采集FDL似乎更适合预防长期功能损害。决策取决于个体患者的需求，应谨慎做出。
