Fennell C W, Phillips P
University of Calgary, Foothills Hospital, Alberta, Canada.
Foot Ankle Int. 1994 Jul;15(7):396-9. doi: 10.1177/107110079401500709.
The observation that, when performing a split anterior tibialis tendon transfer, a twist develops as the distal segment is brought into position on the lateral side of the foot led to our hypothesis that, as a consequence of foot rotation during embryologic development, rotation of the tendon of the anterior tibialis muscle also occurs and can be seen in the adult. Ten unembalmed human lower extremities were examined with regard to the macrostructure of the anterior tibialis tendon. In all 10 specimens, the fibers rotated through 90 degrees from the musculotendinous junction to the insertion on the first cuneiform and metatarsal. The tendon was then split, releasing the first metatarsal insertion in five specimens and the first cuneiform insertion in five. Lateral transfer of the first metatarsal-released group produced a crossing over proximally of the tendon as the fibers came from the medial side of the musculotendinous junction. Lateral transfer of the first cuneiform-released group produced no crossing over proximally as the fibers came from the lateral side of the musculotendinous junction. During a split anterior tibialis tendon transfer, release of the cuneiform insertion will avoid the proximal twisting seen with first metatarsal release and allows for a more direct line of pull of the muscle on the tendon.
在进行胫前肌腱劈开转移时，当远端部分置于足外侧的位置时会出现扭转，这一观察结果引出了我们的假设：由于胚胎发育过程中足部的旋转，胫前肌肌腱也会发生旋转，并且在成年人中也可以观察到。对10具未防腐处理的人类下肢进行了胫前肌腱宏观结构的检查。在所有10个标本中，纤维从肌-腱连接处到在第一楔骨和第一跖骨上的附着点旋转了90度。然后将肌腱劈开，在5个标本中松开第一跖骨附着点，在另外5个标本中松开第一楔骨附着点。第一跖骨松开组的外侧转移在纤维来自肌-腱连接处内侧时导致肌腱在近端交叉。第一楔骨松开组的外侧转移在纤维来自肌-腱连接处外侧时在近端没有交叉。在胫前肌腱劈开转移过程中，松开楔骨附着点将避免第一跖骨松开时出现的近端扭转，并使肌肉对肌腱的牵拉线更直接。
