Beger Orhan, Elvan Özlem, Keskinbora Mert, Ün Burçin, Uzmansel Deniz, Kurtoğlu Zeliha
Mersin University Faculty of Medicine, Department of Anatomy, Mersin, Turkey.
Medipol University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2018 Mar;52(2):134-142. doi: 10.1016/j.aott.2018.01.001. Epub 2018 Feb 1.
The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH).
Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed.
MKH was 12.61 ± 1.11 cm proximal to first interphalangeal joint, 1.75 ± 0.39 cm below to navicular tuberosity and 5.93 ± 0.74 cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 ± 0.60 cm and 9.37 ± 0.77 cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 ± 0.63 cm, 7.03 ± 0.86 cm and 20.22 ± 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL.
The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively.
本研究旨在评估拇长屈肌（FHL）、趾长屈肌（FDL）和副趾长屈肌（FDA）与肌腱移植相关的特征，并揭示亨利主结（MKH）的位置。
解剖了来自梅尔辛大学医学院解剖学系库存的10具福尔马林固定尸体的20只足。确定了MKH的位置。对FHL和FDL的连接进行了分类。根据切口技术，测量了FHL和FDL肌腱移植的长度。评估了FDA的附着部位。
MKH位于距第一指间关节近端12.61±1.11cm、舟骨粗隆下方1.75±0.39cm以及内踝远端5.93±0.74cm处。FHL和FDL的连接分为7种类型。根据内侧和足底入路，FDL的肌腱移植长度分别为6.14±0.60cm和9.37±0.77cm。根据单切口、双切口和微创切口技术，FHL的肌腱移植长度分别为5.75±0.63cm、7.03±0.86cm和20.22±1.32cm。在所有病例中均发现FDA插入到FHL肌腱束，并且它插入到FDL的不同表面。
确定了MKH和肌腱束的确切位置。发现了文献中未记录的两种新连接。观察到FDA的主要附着部位是FHL肌腱束。参与形成趾长屈肌腱的FHL、FDL和FDA之间连接的手术认知，对于减少术后肌腱转移后可能的功能丧失可能很重要。
