星云棋牌官网下载

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                              学术堂专业论文学习平台您当前的位置:学术堂 > 医学论文 > 基础医学论文 > 人体解剖学论文

                              小腿骨间膜的建构和上端裂孔的解剖学分析

                              时间:2019-03-21 来源:解剖学杂志 作者:邱龙恒,刘超,谭明洁, 本文字数:5090字

                                摘    要: 目的 :研究小腿骨间膜上端裂孔的形态结构,为临床深入了解小腿骨间膜的功能,重建和避免胫前血管损伤提供形态学依据。方法 :常规福尔马林固定小腿骨间膜标本40侧,观测胫、腓骨长度;骨间膜结构;骨间膜上端裂孔的形态;裂孔长轴腓侧近端至外踝的距离,计算骨间膜上端裂孔长轴腓侧近端至外踝距离与腓骨长的相关性。结果 :骨间膜由膜性部和腱性部2部分组成。腱性部是一条斜型粗纤维束,位于骨间膜下1/2处,由走行一致的多条细小纤维构成,厚(0. 32±0.12)cm,长(11.1±0.21)cm,与腓骨成角(20. 60°±1.00°)。上端裂孔成椭圆形,上端裂孔长轴长(2.71±1.35)cm、上端裂孔短轴长(1.91±0.21)cm、长轴近端腓侧至外踝最远处距离为(31.21±2.35)cm。胫骨长(34.21±2.36)cm、腓骨长(34.3±2.12)cm。骨间膜上端裂孔长轴腓侧近端至外踝距离与腓骨长正相关。结论:骨间膜对维持胫、腓骨轴向稳定,应力传递和防止小腿损伤后胫、腓骨移位具有重要作用。骨间膜上端裂孔的位置可由腓骨长推算而出。

                                关键词: 小腿; 骨间膜; 解剖学; 轴向稳定;

                                Abstract:星云棋牌官网下载 Objective : To study the morphological structure of the crural interosseous membrane and the superior interosseous membran hiatus so as to provide morphological basis to deeply understand the function of the crural interosseous membrane, reconstruction and prevention of tibial anterior vascular injury in clinical practice. Methods : 40 crural interosseous membranes were fixed with formalin, then the length of tibia and fibula, interosseous membrane structure, appearance of the hiatus, and the distance from proximal lateral fibular end of the long axis of the hiatus to lateral extramalleolus were surveyed. Correlation between the distance from proximal fibula to lateral malleolus and the length of fibula was calculated. Results : Interosseous membrane was made up of the membranous and the tendinous part. The tendinous portion is an oblique bundle of coarse fiber, located 1/2 way under the interosseous membrane, which is composed of several small fibers that run in a uniform fashion. The thickness was(0.32±0.12)cm, and the length was(11.1±0.21)cm. The angle between the coarse fiber bundle and the fibula was(20.60°±1.00°). The upper hiatus was elliptic with the long axial length(2.71±1.35)cm, and the short axial length was(1.91±0.21)cm. The hiatal distance from proximal fibular side to lateral malleolus of the long axis was(31.21±2.35)cm. Tibia length was(34.21±2.36)cm, and fibula length was(34.3±2.12) cm. The distance from the long axis of the upper hiatus to the lateral malleolus was positively correlated with the length of the fibula. Conclusion : Interosseous membrane plays an important role on maintaining the axial stability of tibiofibula, propagation of pressure and preventing the displacement of tibiofibula after fracture of the lower leg. The location of the superior interosseous membrane hiatus can be inferred by the length of the fibula.

                                Keyword: 星云棋牌官网下载crus; interosseous membrane; anatomy; axial stability;

                                XIAOTUIGUJIANMO(intercostal membrane of crus)WEIYIXIANWEIMOXINGJIEGOU,LIANYUJINGFEIGUDEGUJIANJIZHIJIAN。JINGGUGUGANZHONGXIABUWANQUANGUZHE,GUJIANMOYUFEIGUKEQIYIDINGDEGUDINGZUOYONG,YIKENENGYOUYUQILICHUANDIZUOYONGJIANJIEYINQIFEIGUGUZHE。GUJIANMOSHANGDUAN1LIEKONGYOUJINGQIANDONGJINGMAICHUANXING。GUJIANMOQIANHOUBIAOMIANYOUSHENJINGZOUXING,SHENJINGFENZHIYUXIAOTUIDUIYINGDEJUBUJINGLUOXUEWEIYOUYIDINGDEGUANXI[1],MUQIANDUIXIAOTUITUIGUJIANMOJIANGOUJIXIAOTUIGUJIANMOSHANGDUANLIEKONGDEXIANGDUIWEIZHIZHIJINRENGWUZHUYAOWENXIANMINGQUECHANSHU。BENSHIYANZHIZAITONGGUODUIZHENGCHANGCHENGRENXIAOTUIGUJIANMODEJIANGOUJIXIAOTUIGUJIANMOSHANGDUANLIEKONGJINXINGJIEPOUXUEGUANCE,TANTAOQIZAIXIAOTUIYUNDONGHESUNSHANGZHONGDEZUOYONGJILINCHUANGYIYI。

                                1 、材料和方法

                                1.1 、材料

                                成人尸体正常小腿胫腓骨骨间膜标本40侧,男性24侧,女性16侧,40侧均为配对侧。小腿骨间膜标本近端保留完整膝关节并至股骨远端,远端保留至足部。剥离肌肉等软组织显露小腿骨间膜,暴露骨间膜裂孔及周围结构。
                               

                              小腿骨间膜的建构和上端裂孔的解剖学分析
                               

                                1.2 、方法

                              星云棋牌官网下载   YINGYONGYOUBIAOKACHI(JINGQUEDU0.02 mm),LIANGJIAOQI,KACHI,ZAIXIAOTUIGUJIANMOZHONGXIA1/2WEIDUIQICUXIANWEISHUDEHOUDUJIQIXIANGGUANJIAODUJINXINGGUANCE,CUXIANWEISHUHOUDUCELIANGDIANWEIQIZHONGDIAN。GUJIANMOSHANGDUANLIEKONGZHANGZHOU,DUANZHOUYI40CEBIAOBENQIANMIANGUAN(TULVE)HEHOUMIANGUAN(TU1)CELIANG。GUJIANMOSHANGDUANLIEKONGZHANGZHOUFEICEJINDUANZHIWAIHUAIZHANGDU、FEIGUZHANG、JINGGUZHANG,YI40CEBIAOBENHOUMIANGUAN(TU1)CELIANG。YISHANGSUOYOUSHUZHIWEI3CIJUNZHI(x,cm),SHUZHIDETONGJIFENXIJIEGUOJILUXINGSHIWEI(x±s,cm)BIAOSHI。

                                1.3 、相关测量

                              星云棋牌官网下载   JINGGUZHANG(ab)、FEIGUZHANG(cf)、SHANGDUANLIEKONGZHANGZHOUZHANG(de)、SHANGDUANLIEKONGDUANZHOUZHANG、SHANGDUANLIEKONGZHANGZHOUJINDUANFEICEDAOWAIHUAIJULI(cd),(TU1A)。GUJIANMOCUXIANWEISHU(TU1B)、HOUDU、ZHANGDUJIQIYUFEIGUDECHENGJIAO。

                                1.4 、统计学方法

                                CAIYONGSPSS13.0TONGJIXUERUANJIANDUIGUJIANMOSHANGDUANLIEKONGZHANGZHOUQIANMIANGUAN(TULVE)HEHOUMIANGUAN(TU1)CELIANGZHANGDU;GUJIANMOSHANGDUANLIEKONGDUANZHOUQIANMIANGUAN(TULVE)HEHOUMIANGUAN(TU1)CELIANGZHANGDU;JINGGUZHANGHEFEIGUZHANGJINXINGPEIDUItJIANYAN;CAIYONGYONGExcelDUIGUJIANMOSHANGDUANLIEKONGZHANGZHOUFEICEJINDUANZHIWAIHUAIZHANGDUHEFEIGUZHANGXINGXIANXINGXIANGGUANFENXI,r≥0.7XIANGGUANXINGQIANG。

                                2 、结果

                                2.1、 骨间膜的形态结构

                                TOUGUANGTIAOJIANXIA,KEJIANGUJIANMOZHENGTIXIANBOTOUGUANGXINGJIAOHAO,WEIMOXINGBU,QIXIA1/2YOU1SHUCUXIANWEISHU,ZAI40LIBIAOBENJUNKEGUANCHADAO。GUJIANMOZHIJIAOJIANREN,LIANYUJINGFEIGUDEGUJIANJIZHIJIAN。GUJIANMOQIANMIANYOUJINGQIANXUEGUANTIEFUQIXIANGXIAZOUXING,QIQIANHOUMIANYOUXIAOTUIQIANHOUJIQUNFUZHE,FENSANJIQUNXIEDIAOYUNDONGSHICHANSHENGDEYINGLI。QISHANGDUANQIDIANCHUSHAOXIAFANGYOU1TUOYUANXINGLIEKONG,ZHUYAOGONGNENGSHIRANGJINGQIANXUEGUANSHUNLICHUANGUOGUJIANMOJINRUXIAOTUIQIANJINMOQIAO。XIADUANZHONGZHIYUJINGFEIGUYUANDUANLIANJIECHU。GUJIANMODE。JIANXINGBUSHIYITIAOXIEXINGCUXIANWEISHU,WEIYUGUJIANMOXIA1/2CHU,YOUZOUXINGYIZHIDEDUOTIAOXIXIAOXIANWEIGOUCHENG。CUXIANWEISHUQIZHIFEIGUNEICEGUJIANJIXIEXIANGZOUXING,YUFEIGUYUANDUANGUGANCHENGJIAOWEI20.60°±1.00°。CUXIANWEISHUQIDIANSHIFEIGUGUJIANJIDEFUZHEYUANCHUDEGUXINGLONGQI,QIDIANZHIWAIHUAIZUIYUANCHUJULI(16.50±0.26)cm;ZHIDIANSHIJINGFEIGUYUANDUANJIEHECHU,ZHIDIANZHINEI、WAIHUAIZUIYUANCHUJULI(4.58±0.69)cm、(4.85±0.44)cm;PINGJUNZHANGDU(17.40±0.36)cm,TOUGUANGTIAOJIANCEQIHOUDU(0.32±0.12)cm。

                                图1 小腿骨间膜、胫腓骨标本(A)及中下1/2(B)后面观
                              图1 小腿骨间膜、胫腓骨标本(A)及中下1/2(B)后面观

                                Fig 1 Specimens of interosseous membrane and tibia and fibula of lower leg(A)and the middle and lower 1/2(B)(rear view)

                                a:Inner ankle farthest;b:Inside the tibia platform;c:The far lateral ankle;d:Distal long axis of the hole at the upper end of the interosseous membrane;e:Proximal long axis of the hiatus at the upper end of the interosseous membrane;f:Proximal fibular bone;j:Rough fiber bundles

                                2.2 、骨间膜上端裂孔的形态结构

                                GUOWOXUEGUANFENCHAHOUDEJINGQIANXUEGUANJINGGUJIANMOSHANGDUANLIEKONGCHUANXING,GUJIANMOSHANGDUANLIEKONGCHENGTUOYUANXING,LIEKONGZHOUWEIYOUJIAOCUOFUZADEXIXIAOXIANWEIGOUCHENG。GUJIANMOSHANGDUANLIEKONGZHANGZHOUZHANG(2.71±1.35)cm、GUJIANMOSHANGDUANLIEKONGDUANZHOUZHANG(1.91±0.21)cm。GUJIANMOSHANGDUANLIEKONGZHANGZHOUQIANMIANGUAN(TU1)HEHOUMIANGUAN(TULVE)CELIANGZHANGDUXIANGBISHUZHICHAYIWUTONGJIXUEYIYI(P>0.05);GUJIANMOSHANGDUANLIEKONGDUANZHOUQIANMIANGUAN(TU1)HEHOUMIANGUAN(TULVE)CELIANGZHANGDUXIANGBISHUZHICHAYIWUTONGJIXUEYIYI(P>0.05)。

                                2.3、 骨间膜上端裂孔长轴腓侧近端至外踝长度与腓骨长的相关性分析

                              星云棋牌官网下载   GUJIANMOSHANGDUANLIEKONGZHANGZHOUFEICEJINDUANZHIWAIHUAIZUIYUANCHUJULI、JINGGUZHANG,YONGExcelRUANJIANDUI2ZUSHUZHIXINGXIANXINGXIANGGUANFENXI。GUJIANMOSHANGDUANLIEKONGZHANGZHOUFEICEJINDUANZHIWAIHUAIZUIYUANCHUJULI(y1)YUDUIYINGFEIGUZHANG(x1)CHENGZHENGXIANGGUAN(y1=0.91x1,r1=0.78≥0.7);QIETUIDAOCHUy=0.9x。

                                3 、讨论

                                3.1 、小腿骨间膜形态结构的意义

                              星云棋牌官网下载   BENCIDUIXIAOTUIGUJIANMOYANJIUJIEGUOXIANSHIGUJIANMOZHENGTIJIEGOUXIANBOXIWEI,JIEGOUGUANCHAJIAOKUNNAN,GUJIANMOHEQIZHONGXIA1/2DECUXIANWEISHUGONGNENGYOUSUOQUBIE。GUJIANMOYOUXIANZHIJINGFEIGUYIWEIHEYINGLICHUANDIZUOYONG。BIAOBENZHIZUOGUOCHENGXIANSHIGUJIANMOSHANGYOUDALIANGJIROUFUZHE,ZHUYAOGONGNENGSHIJIROUXIEDIAOSHOUSUOSHIQIDAOYINGLIDEFENSANZUOYONG。BIMIANJIROUFUZHEDIANCHUDEJINGFEIGUSITUOXINGGUZHEDEFASHENG。BENCIYANJIUDUIGUJIANMOGUANCHAJIEGUOXIANSHIGUJIANMOZHENGTIXIANBOERJIANREN,YUJINGFEIGULIANJIEJINMI。YOUBAODAOXIAOTUISUNSHANGHOUZUBUQU、SHENLIXIAJIANGYUFEIGUGUJIANJUZENGKUANHEYIWEIXIANGGUAN[2]。LINCHUANGBINGLIHUIGUFEIGUFASHENGGUZHESHISHAOYIWEIHEJINGGUZHIJIESHOULIGUZHEBINGLIZHONGDUOBANFEIGUGUZHE。YINCIBIZHERENWEIGUJIANMOYOUXIANZHIJINGFEIGUYIWEIHEYINGLICHUANDIZUOYONG。GUJIANMOZHONGXIA1/2DECUXIANWEISHUGONGNENGYOUWEICHIJINGFEIGUDEZHOUXIANGWENDINGDEZUOYONG。ZAIBENCIYANJIUZHONGDUIJINGFEIGUGUJIANMOBIAOBENCUXIANWEISHUQIECHUQIANHOU,FENBIEJIJINGFEIGUZHOUXIANGXIANGFANDELI。JIEGUOXIANSHISHICUXIANWEIJIANDUANSHIDEJINGFEIGUFASHENGZHOUXIANGYIWEIDELIGENGXIAO。YINJINGFEIGUYUANDUANYOUJINGFEIRENDAI、ZHONGJIANYOUJINZHANGJIANRENDEGUJIANMO,DUIJINGFEIGUSHIJIAXUANNEIXUANWAIFANGXIANGDELISHIJINGFEIGUXUANZHUANSHOUXIANHUOQINGWEIXUANZHUAN。BENYANJIUJIEGUOXIANSHIXIEXIANGZOUXINGDECUXIANWEISHUWEICHIJINGFEIGUDEZHOUXIANGWENDING。XIAOTUIGUJIANMOJICUXIANWEISHUDEGONGNENGJIJIEPOUJIEGOUMUQIANSHANGWUDINGLUN。YINCIDUIGUJIANMOJICUXIANWEISHUDEJIEGOUJIGONGNENGRENGXUJINYIBULIJIEHERENSHI。

                                3.2、 研究小腿骨间膜上端裂孔位置和形态的意义

                              星云棋牌官网下载   SHOUXIANBENCIYANJIUXIAOTUIGUJIANMOSHANGDUANLIEKONGWEIZHIHEXINGTAI,KEBIMIANXIAOTUIGUJIANMOSHANGDUANLIEKONGYINXIAOTUIJIXINGGUJINMOSHIZONGHEZHENG(acute compartment sndrome,ACS)XINGQIEKAIJIANYASHUSHIDESUNSHANG。ACSSHIYOUYUJIXINGJIANSHINEIYALICHAOGUOXUEGUANGUANZHUYAERDAOZHIJIANSHINEIZUZHIQUEXUECHANSHENGDEYIXILIEZAOQIZHENGZHUANGHETIZHENG。LINCHUANGXIAOTUIFASHENGACSDEHUANZHE,XINGGAOYAYANGJIEHEZAOQIQIEKAIJIANYAZHILIAOHUODANCHUNZAOQIQIEKAIJIANYAZHILIAO[3,4]。YOUYUGUODONGJINGMAIZAIGUJIANMOSHANGDUANLIEKONGCHUFENCHAWEIJINGHOUDONGJINGMAIHEJINGQIANDONGJINGMAI,HOUZHECHUANCILIEKONGJINRUXIAOTUIQIANGUJINMOQIAODEJIEPOUZOUXINGGUANXI[5]。DUOJINMOSHISHOULEIJINGGUJIANMOXINGDANYIQIEKOUJIANYASHI,LINCHUANGANLIBAODAOYOUYINQIEKOUWEIZHIPIANGAODAOZHICILIEKONGSUNSHANG,YINQIXIANWEIXIUFUDAOZHICHUANXINGCHUDEJINGQIANDONGMAIXIANGDUIXIAZHAIHEYINSUNSHANGJINGQIANXUEGUANSUOXUDECILIEKONGQIEKAIXINGJINGQIANDONGMAIYANSHENJINXINGYUANWEIWENHEHUODAQIAO,SHUHOULIEKONGBANHENXIUFUDAOZHIZHANGLIDA[6]。BENCIYANJIUJIEGUOXIANSHILIEKONGZHANGZHOUJINDUANFEICEDAOWAIHUAIZUIYUANCHUDEJULIYUFEIGUDEXIANGGUANXINGHETUOYUANXINGLIEKONGZHANGZHOUZHANG,BIAOMINGACSXINGQIEKAIJIANYASHUSHIWEIBIMIANLIEKONGSUNSHANG,QIEKOUJINDUANBUCHAOGUOFEIGUTOUYIYUANFEIGUZHANGDE1/10JIASHANGLIEKONGZHANGZHOUZHANG,LILUNSHANGKEBIMIANLIEKONGSUNSHANG。DANSHUSHIPOHUAIDEYIBUFENGUJIANMO,QISHIFOUHUIYINGXIANGHUANZHESHUHOUXIAOTUIGONGNENGJIJINGFEIGUWENDINGXING,SHIFOUXUYAOHOUQIZHONGJIAN,HAIXUJINYIBUXINGGUJIANMODESHENGWULIXUEYANJIU。QICI,BENCIYANJIUXIAOTUIGUJIANMOSHANGDUANLIEKONGWEIZHIHEXINGTAIKEWEIXIAOTUISUNSHANGDEZHENZHITIGONGJIEPOUSHUJUZHICHI。GUOWOXUEGUANFENCHAHOUDEJINGQIANXUEGUANJINGGUJIANMOSHANGDUANTUOYUANXINGLIEKONGCHUANXING,CIFENCHADIANCHUDEXUEGUANSUNSHANGLINCHUANGJIEZHUBCHAOJIZUBEIHEJINGHOUDONGMAIBODONGFUZHUZHENZHI[7]。BENYANJIUXIANSHILIEKONGZHANGZHOUJINDUANFEICEDAOWAIHUAIDEJULIYUFEIGUDEXIANGGUANXINGKEWEIYISICICHUXUEGUANSUNSHANGDEZHENDUANTIGONGYIGETIBIAODEFUZHUDINGWEI。CIWAIBENSHIYANJINYIBUYANZHENGLECHUANTONGLINCHUANGXXIANFUZHUJIANCHASUODECHUDETONGYICHENGRENZHENGCHANGJING、FEIGUZHANGDUWUCHAYIJIELUN[8]。CIGUANCEJIEGUOSHUOMINGDUIJING、FEIGUXIADUANFENSUIXINGGUZHENEIGUDINGZHILIAOZHONGHUIFUFEIGUZHANGDU[9],YIJINGGUZHANGWEICANZHAOWUYOUYIDINGDEKEXINGXING。

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                                邱龙恒,刘超,谭明洁,庄敏,张健,刘学敏,李明,李建伟.小腿骨间膜结构及其上端裂孔的临床解剖[J].解剖学杂志,2019,42(06):573-575.
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