Mao Haijiao, Wang Linger, Dong Wenwei, Liu Zhenxin, Yin Weigang, Xu Dachuan, Wapner Keith L
Department of Orthopaedic Surgery, The Affiliated Hospital of Medical school, Ningbo University, No. 247, Renming Road, Jiangbei District, Ningbo, Zhejiang, China.
Department of Anatomy, Medical School of Ningbo University, Ningbo, Zhejiang, China.
Surg Radiol Anat. 2018 Sep;40(9):1031-1038. doi: 10.1007/s00276-018-2021-5. Epub 2018 Apr 16.
The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers.
Seventy embalmed feet from 20 male and 15 female cadavers, the cadavers' mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle. The distance between the musculotendinous junction and the relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined.
Three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%); equal length medial and lateral muscle bellies, this variant was only observed in five specimens (7.1%); one lateral and no medial muscle belly, which was observed in two specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range 2.34-8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in four specimens (5.7%).
Knowing FHL muscle morphology, variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. With posterior arthroscopic for the treatment of various ankle pathologies, posteromedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures because of the gap between the neurovascular bundle and FHL tendon.
本研究旨在评估长屈肌（FHL）肌腱-肌肉连接处解剖变异的发生率，以及在人类尸体的后踝关节水平FHL肌腱或肌肉与胫神经血管束之间的关系。
对来自20具男性和15具女性尸体的70只防腐处理的足部进行解剖，并进行解剖学分类，以观察FHL肌肉形态，确定FHL肌腱或肌肉与胫神经血管束之间的关系。测定肌腱-肌肉连接处的距离以及FHL肌腱或肌肉与胫神经血管束之间的关系。
确定了FHL肌肉的三种形态类型：外侧长而内侧短的肌腹，在63个标本中观察到（90%）；内侧和外侧肌腹长度相等，这种变异仅在5个标本中观察到（7.1%）；一个外侧肌腹且无内侧肌腹，在2个标本中观察到（2.9%）。根据性别或侧别未观察到统计学显著差异（p＞0.05）。确定并描述了FHL肌腱或肌肉与胫神经血管束之间的两种模式。模式1，神经血管束与FHL肌腱之间的距离为3.46毫米（范围2.34 - 8.84，标准差 = 2.12），在66个标本中观察到（94.3%）；模式2，在4个标本中观察到无距离（5.7%）。
了解FHL肌肉形态、变异为跟腱缺损的FHL转移的安全规划和实施以及超声和磁共振图像的解读提供了新的重要见解。对于后关节镜治疗各种踝关节病变，由于神经血管束与FHL肌腱之间的间隙，后内侧入路可引入踝关节后方而不会对胫神经血管结构造成严重损伤。
