三角韧带解剖学影像学及生物力学.pptx

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1、会计学1三角韧带解剖学影像学及生物力学三角韧带解剖学影像学及生物力学三角韧带的解剖三角韧带的解剖三角韧带的解剖三角韧带的解剖The Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligament三角韧带分为两层三角韧带分为两层三角韧带分为两层三角韧带分为两层6 6 6 6束束束束，浅层浅层浅层浅层4 4 4 4束，深层束，深层束，深层束，深层2 2 2 2束束束束pp浅层浅层:胫舟韧带、胫胫舟韧带、胫跳跃跳跃韧带、胫跟

2、韧带及胫距后韧带浅层韧带、胫跟韧带及胫距后韧带浅层 TibioTibionavicular ligament,Tibiospring ligament,Tibiocalcaneal ligament,Superficialnavicular ligament,Tibiospring ligament,Tibiocalcaneal ligament,Superficial posterior tibiotalar ligament.posterior tibiotalar ligament.pp深层深层:胫距前韧带深层及胫距后韧带深层胫距前韧带深层及胫距后韧带深层 Deep anterior t

3、ibiotalar ligament,Deep posterior tibiotalar ligament.Deep anterior tibiotalar ligament,Deep posterior tibiotalar ligament.第1页/共22页三角韧带的解剖三角韧带的解剖三角韧带的解剖三角韧带的解剖The Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligament第2页/共22页三角韧带的解剖三角

4、韧带的解剖三角韧带的解剖三角韧带的解剖The Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentABC图图1.A.胎儿踝部冠状面（Mallory三色法染色），1.内踝，2.三角韧带深层，3.三角韧带浅层，4.胫后肌腱，5.趾长屈肌腱，6.载距突，7.踇长屈肌腱，8.纤维鞘隔膜。B.三角韧带浅层示意图，1.胫舟韧带，2.胫弹性韧带，3.胫跟韧带，4.胫距后韧带浅层，5.跟舟上韧带（弹性韧带组成部分）6.胫后肌

5、腱，7.跖侧跟舟韧带（弹性韧带组成部分）C.三角韧带深层，1.胫距前韧带深层，2.胫距后韧带深层。第3页/共22页Fig.1.Tibionavicular ligament.2.Deep anterior tibiotalar ligament(deep layer).3.Tibiospring ligament.4.Tibiocalcaneal ligament.5.Deep posterior tibiotalar ligament(deep layer).6.Superomedial calcaneonavicular ligament(component of spring ligam

6、ent).7.Plantar calcaneonavicular ligament(component of spring ligament).8.Navicular tuberosity.9.Medial talar process.10.Sustentaculum tali.11.Posterior tibial tendon(cut at the level of the insertion).12.Flexor hallucis longus(cut proximal and distal).13.Tibialis anterior tendon(cut at the level of

7、 insertion).14.Long plantar ligament.15.Plantar calcaneocuboid ligament.16.Calcaneal tendon(cut at the level of insertion)三角韧带的解剖三角韧带的解剖三角韧带的解剖三角韧带的解剖The Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligament第4页/共22页三角韧带的解剖三角韧带的解剖三角韧带

8、的解剖三角韧带的解剖The Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentThe Anatomy of deltoid ligamentFig.3 Medial view of the anatomical dissection of the deep layer of the deltoid ligament.The superficial layer of the deltoid ligament has been resected.Its distal in

9、sertion is maintained(arrowheads).a Plantar flexion.b Dorsiflexion.1.Deep anterior tibiotalar ligament.2.Deep posterior tibiotalar ligament.3.Talar head.4.Medial talar process.5.Sustentaculum tali.6.Anterior subtalar joint.7.Posterior tibialtendon(cut at the level of insertion)第5页/共22页三角韧带影像学（附着点）三角

10、韧带影像学（附着点）三角韧带影像学（附着点）三角韧带影像学（附着点）The Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligament第6页/共22页Figure 4.Representative lateral radiographic images of a right ankle demonstrating the sites of attachment and courses

11、 of the individual bands of the(A)superficial and(B)deep deltoid:DATT,deep anterior tibiotalar ligament;DPTT,deep posterior tibiotalar ligament;SL,spring ligament;SPTT,superficial posterior tibiotalar ligament;TC,tibiocalcaneal ligament;TN,tibionavicular ligament;TS,tibiospring ligament.第7页/共22页三角韧带

12、的附着点三角韧带的附着点三角韧带的附着点三角韧带的附着点The Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentDATT,deep anterior tibiotalar ligament;DPTT,deep posterior tibiotalar ligament;SL,spring ligament;SPTT,superficial posterior tibiota

13、lar ligament;TC,tibiocalcaneal ligament;TN,tibionavicular ligament;TS,tibiospring ligament.第8页/共22页三角韧带的三角韧带的三角韧带的三角韧带的MRIMRIMRIMRIThe MRI of deltoid ligamentThe MRI of deltoid ligamentThe MRI of deltoid ligamentThe MRI of deltoid ligament第9页/共22页三角韧带的三角韧带的三角韧带的三角韧带的MRIMRIMRIMRIThe MRI of deltoid li

14、gamentThe MRI of deltoid ligamentThe MRI of deltoid ligamentThe MRI of deltoid ligamentMR images in 56 asymptomatic subjectsFigure 2:Anterior TTL(anterior portion of the deep layer of the MCL complex)and TSL(middle portion of the superficial layer of the MCL complex)in asymptomatic 25-year-old man.第

15、10页/共22页三角韧带的三角韧带的三角韧带的三角韧带的MRIMRIMRIMRIThe MRI of deltoid ligamentThe MRI of deltoid ligamentThe MRI of deltoid ligamentThe MRI of deltoid ligamentMR images in 56 asymptomatic subjects第11页/共22页三角韧带的三角韧带的三角韧带的三角韧带的MRIMRIMRIMRIThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe

16、Attachments of deltoid ligamentThe Attachments of deltoid ligament第12页/共22页三角韧带的三角韧带的三角韧带的三角韧带的MRIMRIMRIMRIThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligamentThe Attachments of deltoid ligament第13页/共22页三角韧带的功能三角韧带的功能三角韧带的功能三角韧带的功能The function of

17、deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligament 踝踝关关节节是是人人体体中中最最为为脆脆弱弱的的负负重重关关节节，其其稳稳定定性性至至关关重重要要。研研究究发发现现，踝踝踝踝关关关关节节节节最最最最主主主主要要要要的的的的稳稳稳稳定定定定结结结结构构构构为为为为内内内内侧侧侧侧三三三三角角角角韧韧韧韧带带带带而而而而非非非非外外外外侧侧侧侧结结结结构构构构1-31-31-31-3。Close Close JRJR等等4

18、4研研究究发发现现当当切切断断所所有有踝踝关关节节外外侧侧韧韧带带而而保保留留三三角角韧韧带带时时，距距骨骨移移位位不不超超过过2mm2mm；而而当当踝踝关关节节外外侧侧韧韧带带完完整整而而深深层层三三角角前前带带断断裂裂时时，距距骨骨平平均均移移位位将将达达到到3.7mm3.7mm。BodenBoden等等在在切切断断下下胫胫腓腓前前、后后韧韧带带后后，由由远远端端向向近近端端逐逐渐渐切切断断骨骨间间膜膜至至踝踝上上15cm15cm，结结果果发发现现在在三三角角韧韧带带完完整整时时,下下胫胫腓腓最最大大分分离离距距离离为为1.4mm1.4mm，而而当当三三角角韧韧带带断断裂裂时时,下下胫胫腓

19、腓分分离离达达到到4.5mm4.5mm，BodenBoden等等认认为为三三角角韧韧带带是是维维持持踝踝关关节节稳稳定定性的首要因素性的首要因素55。第14页/共22页 三角韧带对踝关节的稳定作用越来越受到国内外学者的重视。三角韧带对踝关节的稳定作用越来越受到国内外学者的重视。RasmussenRasmussen等等66发现三角韧带浅层主要限发现三角韧带浅层主要限制距骨外移及外翻，三角韧带深层主要限制距骨的外旋。制距骨外移及外翻，三角韧带深层主要限制距骨的外旋。Ziai PZiai P等等77通过体外生物力学研究发现在外侧通过体外生物力学研究发现在外侧副韧带损伤的情况下，三角韧带浅层阻止了踝关

20、节继续外旋或外翻，而深层结构在稳定距下关节所起副韧带损伤的情况下，三角韧带浅层阻止了踝关节继续外旋或外翻，而深层结构在稳定距下关节所起的作用较小，因此三角韧带浅层在踝关节外侧稳定中起到了重要的作用。的作用较小，因此三角韧带浅层在踝关节外侧稳定中起到了重要的作用。EarllEarll等等88报道切断浅层三角韧报道切断浅层三角韧带后，胫距关节接触面积下降带后，胫距关节接触面积下降43%43%，压力峰值增加，压力峰值增加30%30%，距骨外移，距骨外移4mm4mm。复旦大学上海医学院马昕教授。复旦大学上海医学院马昕教授及其研究生根据尸体解剖结果提出胫舟韧带可能只是踝关节囊加强组织，三角韧带在踝关节屈

21、伸运动及其研究生根据尸体解剖结果提出胫舟韧带可能只是踝关节囊加强组织，三角韧带在踝关节屈伸运动过程中存在韧带束间交替工作机制。同济大学附属同济医院俞光荣教授认为三角韧带对踝关节的稳定过程中存在韧带束间交替工作机制。同济大学附属同济医院俞光荣教授认为三角韧带对踝关节的稳定作用非常重要作用非常重要99。三角韧带的功能The function of deltoid ligament第15页/共22页三角韧带的功能三角韧带的功能三角韧带的功能三角韧带的功能 （选择其中一篇文献复习）（选择其中一篇文献复习）（选择其中一篇文献复习）（选择其中一篇文献复习）The function of deltoid l

22、igamentThe function of deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligament第16页/共22页三角韧带的功能三角韧带的功能三角韧带的功能三角韧带的功能The function of deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligamentThe preset torsion between tibia

23、 and calcaneus was primarily set at 30 of internal rotation on specimen in plantar flexion and hind foot inversion.The first series of measurements were performed on healthy specimens andthe following after transecting structures in following order:anterior talofibular ligament(ATFL)in combination w

24、ith calcaneofibular ligament(CFL),followed by anterior tibiotalar ligament and posterior tibiotalar ligament and finally tibiocalcaneal ligament(TCL).第17页/共22页三角韧带的功能三角韧带的功能三角韧带的功能三角韧带的功能The function of deltoid ligamentThe function of deltoid ligamentThe function of deltoid ligamentThe function of d

25、eltoid ligamentThe combined lateral ATFL and CFL instability showed a decrease in the resisting torque,which ensures stability in ankle sprain trauma.Only a transection of TCL(superficial layer of deltoid ligament complex)with existing lateral dual-ligament instability results in a significant decre

26、ase in torque(p 0.0001).第18页/共22页Take home messagesTake home messagespp三角韧带三角韧带2 2层层6 6束，浅束，浅4 4深深2 2ppX X线韧带束起止点定位重要，临床使用价值大线韧带束起止点定位重要，临床使用价值大pp踝关节最主要的稳定结构为内侧三角韧带踝关节最主要的稳定结构为内侧三角韧带第19页/共22页 ReferencesReferencesReferencesReferences 11 Schuberth JM,Collman DR,Rush SM,Ford LA.Deltoid ligament integri

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34、900-6.88 Earll M,Wayne J,Brodrick C,Vokshoor A,Adelaar R.Contribution of the deltoid ligament to ankle joint contact Earll M,Wayne J,Brodrick C,Vokshoor A,Adelaar R.Contribution of the deltoid ligament to ankle joint contact characteristics:a cadaver study.Foot Ankle Int.1996;17:317-24.characteristi

35、cs:a cadaver study.Foot Ankle Int.1996;17:317-24.99 Yu GR,Zhang MZ,Aiyer A,Tang X,Xie M,Zeng LR,et al.Repair of the acute deltoid ligament complex rupture Yu GR,Zhang MZ,Aiyer A,Tang X,Xie M,Zeng LR,et al.Repair of the acute deltoid ligament complex rupture associated with ankle fractures:a multicen

36、ter clinical study.The Journal of foot and ankle surgery:official publication of the associated with ankle fractures:a multicenter clinical study.The Journal of foot and ankle surgery:official publication of the American College of Foot and Ankle Surgeons.2015;54:198-202.American College of Foot and Ankle Surgeons.2015;54:198-202.第20页/共22页 守 破 离第21页/共22页