PhD Candidate, Medical Science Programme, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
Faculty of Physical Therapy, Huachiew Chalermprakiet University, Samutprakan, Thailand.
Folia Morphol (Warsz). 2021;80(2):415-424. doi: 10.5603/FM.a2020.0045. Epub 2020 Apr 17.
Length of flexor hallucis longus (FHL), localisation of master knot of Henry (MKH) and relationship between MKH and neurovascular bundle are essential for the achievement of FHL tendon transfer. The purpose of this study is to define the localisation of MKH in reference to bony landmarks of the foot, its relationship to plantar neurovascular bundle and to investigate in situ and ex vivo length of FHL tendon in single incision, double incision and minimally invasive techniques.
Foot length was examined in 62 feet of 31 soft cadavers (9 males, 22 females). Various parameters including the relationship between MKH and neurovascular bundle, the distances from MKH to medial malleolus (MM), navicular tuberosity (NT) and the first interphalangeal joint of great toe (IP) were measured. Surface localisation of MKH in relation to a line joining the medial end of plantar flexion crease at the base of great toes (MC) to NT (MC-NT line) was determined. Lengths of FHL tendon graft from three surgical techniques were examined. In situ length was measured in the plantar surface of foot and ex vivo length was measured after tendon was cut from its insertion.
The mean length of foot was 230.98 ± 15.35 mm with a statistically significant difference between genders in both sides (p < 0.05). No distance was found between medial plantar neurovascular bundle (MPNVB) and MKH. Mean distance of 17.13 ± 3.55 mm was found between lateral plantar neurovascular bundle (LPNVB) and MKH. MKH was located at a mean distance of 117.11 ± 1.00 mm proximal to IP, 26.28 ± 4.75 mm under NT and 59.58 ± 7.51 mm distal to MM with a statistically significant difference of MKH-IP distance between genders in both sides and MKH-NT in right side. MKH was located anterior to NT (66.1%), at NT (27.4%) and posterior to NT (6.5%) on the MC-NT line. Surface localisation of MKH was 94.75 ± 8.43% of MC-NT line from MC with a perpendicular distance of 25.11 ± 5.37 mm below MC-NT line. The in situ and ex vivo tendon lengths from MTJ to ST, to MKH and to IP were 39.05 ± 10.88 mm and 34.43 ± 10.23 mm, 73.45 ± 9.91 mm and 68.63 ± 9.43 mm, 197.98 ± 13.89 and 191.79 ± 14.00 mm, respectively. A statistically significant difference between genders was found in MTJ-IP of in situ and ex vivo length of both sides (p < 0.05). The mean length of tendon between in situ and ex vivo was significantly different in all techniques (p < 0.05). A moderate positive correlation between foot length and tendon length was found in MTJ-IP of both in situ and ex vivo tendon length.
A statistically significant difference between in situ and ex vivo tendon length was shown in all harvesting techniques. Surface location of MKH was approximately at 95% of MC-NT line from MC with a perpendicular distance of 25 mm from MC-NT line.
在进行踇长屈肌腱转位时，了解踇长屈肌腱（FHL）的长度、亨利结（MKH）的定位以及 MKH 与神经血管束之间的关系至关重要。本研究的目的是确定 MKH 在足部骨标志上的定位、它与足底神经血管束的关系，并研究单切口、双切口和微创技术中 FHL 肌腱的原位和离体长度。
检查了 31 个尸体（9 名男性，22 名女性）的 62 只脚的足部长度。测量了包括 MKH 与神经血管束之间的关系、MKH 到内踝（MM）、舟状骨结节（NT）和大脚趾第一指间关节（IP）的距离在内的各种参数。确定了 MKH 在从大脚趾跖屈褶皱内侧末端（MC）到 NT 的连线（MC-NT 线）上的表面定位。检查了三种手术技术的 FHL 肌腱移植物的长度。原位长度在足底表面测量，离体长度在从附着点切断肌腱后测量。
足部的平均长度为 230.98 ± 15.35mm，男女两侧的长度均存在统计学差异（p < 0.05）。内侧足底神经血管束（MPNVB）与 MKH 之间没有距离。外侧足底神经血管束（LPNVB）与 MKH 之间的平均距离为 17.13 ± 3.55mm。MKH 距 IP 近端平均距离为 117.11 ± 1.00mm，距 NT 下方 26.28 ± 4.75mm，距 MM 远端 59.58 ± 7.51mm，男女两侧 IP 处的 MKH 距离和右侧的 MKH-NT 距离存在统计学差异。MKH 在 NT 前方（66.1%）、NT 处（27.4%）和 NT 后方（6.5%）。MKH 在 MC-NT 线上的表面定位距 MC 为 94.75 ± 8.43%，垂直距离为 MC-NT 线下方 25.11 ± 5.37mm。MTJ 至 ST、MKH 和 IP 的原位和离体肌腱长度分别为 39.05 ± 10.88mm 和 34.43 ± 10.23mm、73.45 ± 9.91mm 和 68.63 ± 9.43mm、197.98 ± 13.89mm 和 191.79 ± 14.00mm。男女两侧 MTJ-IP 的原位和离体长度均存在统计学差异（p < 0.05）。所有技术的原位和离体肌腱长度之间的平均肌腱长度差异均有统计学意义（p < 0.05）。在 MTJ-IP 处，原位和离体肌腱长度之间存在中度正相关。
所有肌腱采集技术中，原位和离体肌腱长度均存在统计学差异。MKH 的表面位置距 MC-NT 线的 MC 侧约为 95%，距 MC-NT 线垂直距离为 25mm。
