Draenert K, Müller M E
Anat Anz. 1980;147(2):188-200.
The direction of movement and the range of movement of a joint are determined by the lengths of the ligaments and the positions of their origins and insertions. It follows that any operation which alters the length of a ligament or moves one of its points of attachment is unphysiological. Reconstruction should be carried out with due regard to the normal anatomy. In the ankle joint, for example, the tip of the lateral malleolus should be left free of ligamentary insertions. Until now, anatomical illustrations have shown the lateral ligaments of the ankle joint to be attached to the anterior border of the fibula and to its anterior and lateral surface. All the older illustrations emphasize a band of fibers which passes directly from the neck of the talus to the calcaeus. This band varies in thickness and always forms the base of the triangle formed by the anterior talofibular ligament and the calcaneofibular ligament. Examination of surgical specimens and amputated ankle joints shows that the lateral tip of the fibula is free of ligamentary insertions. The lateral fibular ligaments are attached to the distal end of the fibula around the border of the cartilaginous foint surface. The only fibers which are derived from the lateral surface are those from the periosteum. This fact is of considerable importance in reconstructive surgery of the ankle joint, since strong ligamentary insertions which surround the lateral surface of the fibula necessarily oppose rotation or screw-like movement of the fibula about its longitudinal axis.
关节的运动方向和运动范围由韧带的长度及其起止点的位置决定。因此，任何改变韧带长度或移动其附着点之一的手术都是不符合生理的。重建手术应充分考虑正常解剖结构。例如，在踝关节中，外踝尖应无韧带附着。到目前为止，解剖学插图显示踝关节的外侧韧带附着于腓骨的前缘及其前表面和外侧表面。所有早期的插图都强调有一束纤维直接从距骨颈延伸至跟骨。这束纤维厚度各异，始终构成由距腓前韧带和跟腓韧带形成的三角形的底边。对手术标本和截肢踝关节的检查表明，腓骨外侧尖无韧带附着。腓骨外侧韧带附着于腓骨远端软骨关节面边缘周围。唯一源自外侧表面的纤维是来自骨膜的纤维。这一事实在踝关节重建手术中具有相当重要的意义，因为环绕腓骨外侧表面的强大韧带附着必然会阻碍腓骨围绕其纵轴的旋转或螺旋状运动。
