Goh J C, Lee P Y, Lee E H, Bose K
Department of Orthopaedic Surgery, National University of Singapore.
Clin Orthop Relat Res. 1995 Oct(319):297-302.
Two methods are used to route the tibialis posterior tendon anteriorly to achieve dorsiflexion: (1) around the medial side of the tibia, or the subcutaneous route; and (2) through the interosseous membrane, or the interosseous route. This study determined the effect of site of tendon insertion on ankle and foot motions and compared the efficacy of both routes. Eleven fresh normal cadaveric legs were used. The detached tibialis posterior tendon was transferred anteriorly through the interosseous membrane and anchored to the first cuneiform along the first metatarsal axis by a barbed staple. The specimen was mounted on a mechanical testing machine. Tension was applied to the tendon and ankle and foot motions were measured. The experimental procedure was repeated with tendon insertion along the second metatarsal axis and serially through to the fifth metatarsal axis. The entire experiment was repeated using the subcutaneous route. The interosseous route was more effective in achieving maximum dorsiflexion with minimal pronation. Shifting the insertion medially caused supination, whereas a more lateral insertion caused pronation.
（1）绕过胫骨内侧，即皮下路径；（2）穿过骨间膜，即骨间路径。本研究确定了肌腱插入部位对踝关节和足部运动的影响，并比较了两种路径的疗效。使用了11条新鲜正常尸体下肢。将离断的胫后肌腱通过骨间膜向前转移，并通过带倒刺的吻合钉沿第一跖骨轴线固定于第一楔骨。将标本安装在机械试验机上。对肌腱施加张力并测量踝关节和足部运动。沿着第二跖骨轴线并依次直至第五跖骨轴线插入肌腱，重复实验步骤。使用皮下路径重复整个实验。骨间路径在以最小的内旋实现最大背屈方面更有效。向内侧移动插入点会导致外旋，而更外侧的插入点会导致内旋。
