跟骨载距突与其外侧壁关系的测量

【摘要】  目的 研究跟骨载距突与其外侧壁的解剖关系，获得通过跟骨外侧壁固定载距突螺钉的安全通道。方法 测量跟骨骨骼标本50副，确定跟骨外侧壁理想的进钉点和进钉角度方向。取30例防腐处理的足，根据测得数据钻入直径3.5 mm的钢针，观察钢针在载距突的位置及其与后关节面关系。结果 通过三臂形跟骨钢板的上臂以理想的进钉点和角度可以钻入直径4.0 mm全螺纹钛钉两枚。其前点螺钉平均长度为41.84 mm，与跟骨外侧面平均呈69.41°、与跟骨外侧面的底垂面平均呈22.67°；后点螺钉平均长度为42.28 mm，与跟骨外侧面平均呈68.45°、与跟骨外侧面的底垂面平均呈20.79°；30足60枚钢针有2枚钻出跟骨后关节面，钻入安全率为97.67%。结论 根据所测得的解剖数据可以确定通过跟骨外侧壁固定载距突螺钉的安全通道。 
【关键词】  跟骨 解剖 骨折
［ABSTRACT］ObjectiveTo study the anatomy of calcaneous sustentaculum tali and paries lateralis, and confirm the safe fixation pathway for  sustentaculum tali and paries lateralis.MethodsFifty pairs of calcaneous specimen were measured to study the ideal site and direction of paries lateralis of calcaneous. Based on the data measured, two 3.5 mm?diameter nails were drilled into each of the 30 antiseptic sample feet. The position of the nail and its relationship with the post articular facet of calcaneous were observed.ResultsTwo 4.0 mm?diameter nails were drilled through the upper arm of three arm pattern calcaneous plate according to the measured ideal site and direction. The screw length of prefixed point was 41.84 mm, the screw angle with paries lateralis was 69.41°, the screw angle with inferior verticular plane of paries lateralis was 22.67°; the  length of postfixed  point was 42.28 mm, the angle with paries lateralis was 68.45°, the angle with inferior verticular plane of paries lateralis was 20.79°. Of the 60 nails drilled, two were drilled out of the post facies articularis of calcaneous, the accuracy rate was 97.67%.ConclusionA safe pathway through paries lateralis for sustentaculum tali fixation could be decided based on the anatomic data.
    ［KEY WORDS］calcaneous; anatomy; fracture
    近几十年来，随着对跟骨骨折病理解剖知识的进一步认识，使外科医生能够对跟骨骨折通过手术治疗获得较好的临床疗效，但目前没有详细的以临床治疗为出发点的载距突与外侧壁的解剖数据。本文通过测量载距突与跟骨外侧壁三维解剖关系，获得通过跟骨外侧壁固定载距突螺钉的理想的进钉位置和进钉角度，可以改善临床治疗特别是手术固定的效果，减少并发症，获得更好的临床治疗效果。
    1  材料和方法
    1.1  材料
    干燥国人尸体跟骨骨骼标本50副（青岛大学医学院人体解剖学教研室提供），左右各50个，男性62个，女性38个，所有测量骨骼标本排除畸形和骨质有破坏或严重增生者。平板玻璃两块、跟骨固定夹两个（自制）、游标卡尺、钢板尺、直角三角尺、工程外径测量尺。
    1.2  方法
    1.2.1  确定跟骨外侧壁的理想进针点  于跟骨后关节面外侧前下缘到滑车突上缘连线的中点作后关节面外侧缘的平行线，相交于跟骨外侧面后上缘的骨嵴，把该连线3等分，等分点定为跟骨外侧壁的理想进针点。确定为前点a，后点b（图1、2）。
    1.2.2  确定载距突测量点  载距突内侧面类似四边形，取其长轴的中轴线，3等分该线确定前后A、B两点，把A、B两点确定为固定螺丝钉在载距突的理想的末端位置（图1、2）。