Edama Mutsuaki, Ikezu M, Kaneko F, Kikumoto T, Takabayashi T, Hirabayashi R, Inai T, Kageyama I
Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Shimami-cho 1398, kita-ku, Niigata, 950-3198, Japan.
Department of Anatomy, School of Life Dentistry at Niigata, Nippon Dental University, Niigata, Japan.
Surg Radiol Anat. 2019 Jan;41(1):3-7. doi: 10.1007/s00276-018-2089-y. Epub 2018 Aug 20.
Damage to the bifurcate ligament is one of the most difficult injuries to diagnose from imaging techniques. A probable reason for this is that the morphological characteristics of this structure have yet to be sufficiently elucidated. We, therefore, endeavored to elucidate the morphological characteristics of the bifurcate ligament through a large-scale study involving numerous specimens.
This study included 100 feet from 52 formalin-fixed cadavers. The bifurcate ligament was classified into three types: presence of both calcaneonavicular ligament and calcaneocuboid ligament (Type I); absence of calcaneocuboid ligament (Type II); and absence of calcaneonavicular ligament (Type III). Morphological characteristics of the bifurcate ligament were determined by measuring fiber bundle length, width, and thickness at the center of each ligament.
This classification resulted in 68 Type I feet (68%), 32 Type II feet (32%), and 0 Type III feet (0%). The calcaneonavicular ligament was 20.8 ± 2.9 mm long, 4.9 ± 1.2 mm wide, and 3.8 ± 1.1 mm thick. The calcaneocuboid ligament was approximately 10.5 ± 2.7 mm long, 4.7 ± 2.4 mm wide, and 1.5 ± 0.6 mm thick. The bifurcate ligament was located deep under the extensor hallucis brevis and extensor digitorum brevis muscles in all specimens. The calcaneal origin of the calcaneonavicular ligament was situated deep under the interosseous talocalcaneal ligament in all specimens. Two sides were identified in which the calcaneocuboid ligament was located deep under the dorsal calcaneocuboid ligament.
Such variations and positional relationships were suggested to be factors complicating the diagnostic imaging of bifurcate ligament injuries. The present study results will likely form useful basic data for diagnostic imaging.
分叉韧带损伤是影像学检查中最难诊断的损伤之一。一个可能的原因是该结构的形态特征尚未得到充分阐明。因此，我们试图通过一项涉及大量标本的大规模研究来阐明分叉韧带的形态特征。
本研究包括来自52具福尔马林固定尸体的100只足。分叉韧带分为三种类型：跟舟韧带和跟骰韧带均存在（I型）；无跟骰韧带（II型）；无跟舟韧带（III型）。通过测量每条韧带中心处的纤维束长度、宽度和厚度来确定分叉韧带的形态特征。
该分类结果为68只I型足（68%），32只II型足（32%），0只III型足（0%）。跟舟韧带长20.8±2.9毫米，宽4.9±1.2毫米，厚3.8±1.1毫米。跟骰韧带长约10.5±2.7毫米，宽4.7±2.4毫米，厚1.5±0.6毫米。在所有标本中，分叉韧带位于拇短伸肌和趾短伸肌深面。在所有标本中，跟舟韧带的跟骨起点位于距跟骨间韧带深面。有两侧跟骰韧带位于跟骰背侧韧带深面。
这些变异和位置关系被认为是使分叉韧带损伤诊断成像复杂化的因素。本研究结果可能会成为诊断成像的有用基础数据。
