胫骨前肌腱形态的尸体解剖与超声研究——一种新分类法的提议
A cadaveric and sonographic study of the morphology of the tibialis anterior tendon - a proposal for a new classification.
作者信息
Olewnik Łukasz, Podgórski Michał, Polguj Michał, Topol Mirosław
机构信息
1Department of Normal and Clinical Anatomy, Interfaculty Chair of Anatomy and Histology, Medical University of Lodz, Lodz, Poland.
2Department of Diagnostic Imaging Lodz, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
出版信息
J Foot Ankle Res. 2019 Feb 1;12:9. doi: 10.1186/s13047-019-0319-0. eCollection 2019.
BACKGROUND
The tibialis anterior tendon (TAT) presents little morphological variation. The tibialis anterior muscle originates at the lateral condyle of the tibia, the proximal one-third to two-thirds of the lateral surface of the tibia shaft, and the anterior surface of the interosseous membrane and inserts to the medial cuneiform bone and first metatarsal. The aim of our work is to classify types of TAT insertion by two complimentary methods - anatomical dissection and ultrasound examination.
METHODS
In the first part, classical anatomical dissection was performed on 100 lower limbs (50 right, 50 left) fixed in 10% formalin solution. The morphology of the insertion of the tendon was evaluated and the muscle was subjected to the appropriate morphometric measurements. In the second part, the morphology of the TAT insertion was evaluated in 50 volunteers with ultrasound.
RESULTS
The tibialis anterior muscle was present in all specimens. In the cadavers, five types of insertion were observed, the most common being Type V: a single band attaching to the medial cuneiform bone (32%). In the sonographic part, Type IV was not observed; however, an additional insertion type was recognised (Type VI), which was characterized by two identical bands attached only to the medial cuneiform bone. The most common type identified by ultrasound was Type II (35%).
CONCLUSION
The tibialis anterior tendon presents high morphological variability that can be observed both in cadavers and in vivo by ultrasound examination.
LEVEL OF EVIDENCE
II Prospective Comparative Study.
背景
胫骨前肌腱（TAT）形态变化较小。胫骨前肌起于胫骨外侧髁、胫骨干外侧表面近三分之一至三分之二处以及骨间膜前面，止于内侧楔骨和第一跖骨。我们研究的目的是通过两种互补方法——解剖 dissection 和超声检查对 TAT 止点类型进行分类。
方法
第一部分，对 100 条固定于 10%甲醛溶液中的下肢（50 条右侧，50 条左侧）进行经典解剖 dissection。评估肌腱止点的形态，并对肌肉进行适当的形态测量。第二部分，对 50 名志愿者进行超声检查，评估 TAT 止点的形态。
结果
所有标本中均存在胫骨前肌。在尸体标本中，观察到五种止点类型，最常见的是 V 型：一条单独的束带附着于内侧楔骨（32%）。在超声检查部分，未观察到 IV 型；然而，识别出一种额外的止点类型（VI 型），其特征为两条相同的束带仅附着于内侧楔骨。超声检查确定的最常见类型是 II 型（35%）。
结论
胫骨前肌腱呈现出高度的形态变异性，在尸体和活体中通过超声检查均可观察到。
证据水平
II 前瞻性比较研究。
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