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[1]葉永亮,霍力為,羅曼,等.跟痛癥相關(guān)的解剖學(xué)研究[J].中醫(yī)正骨,2019,31(02):1-4.
　YE Yongliang,HUO Liwei,LUO Man,et al.An anatomical study associated with calcaneodynia[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2019,31(02):1-4.
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跟痛癥相關(guān)的解剖學(xué)研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第31卷
期數(shù):
2019年02期
頁碼:
1-4
欄目:
基礎(chǔ)研究
出版日期:
2019-02-20

文章信息/Info

Title:
An anatomical study associated with calcaneodynia
作者:
葉永亮1; 霍力為1; 羅曼1; 楊廣鋼1; 廖立青2; 武凱2; 陳塵3; 李義凱2
(1.廣州市正骨醫(yī)院,廣東 廣州 510045; 2.南方醫(yī)科大學(xué)中醫(yī)藥學(xué)院,廣東 廣州 510515; 3.南方醫(yī)科大學(xué)第一臨床醫(yī)學(xué)院,廣東 廣州 510515)
Author(s):
YE Yongliang1; HUO Liwei1; LUO Man1; YANG Guanggang1; LIAO Liqing2; WU Kai2; CHEN Chen3; LI Yikai2
1.Guangzhou Orthopedic Hospital,Guangzhou 510045,Guangdong,China; 2.College of Traditional Chinese Medicine of Southern Medical University,Guangzhou 510515,Guangdong,China; 3.The First Clinical Medical College of Southern Medical University,Guangzhou 510515,Guangdong,China
關(guān)鍵詞:
足跟痛;  跟骨骨刺;  筋膜炎; 足底;  解剖
Keywords:
heel pain;  heel spur;  fasciitis; plantar;  dissection
摘要:
目的:探討跟骨骨刺和小趾展神經(jīng)走行的解剖學(xué)特點。方法:選取589具干燥完整的成人跟骨標(biāo)本和10具以10%甲醛固定的下肢標(biāo)本(范圍包括小腿中段以下)。在跟骨標(biāo)本上仔細(xì)觀察是否存在骨刺,記錄骨刺的形態(tài)、位置、數(shù)量,測量骨刺的長度和寬度,觀察跖筋膜和趾短屈肌在跟骨的附著部位。從足背逐層解剖下肢標(biāo)本,分離并觀察小趾展神經(jīng)走行及周圍的結(jié)構(gòu)。結(jié)果:589具跟骨標(biāo)本中,左側(cè)跟骨293具、右側(cè)跟骨296具。119具跟骨骨刺位于跟骨結(jié)節(jié)內(nèi)側(cè)突前緣,部分跟骨骨刺還出現(xiàn)在跟骨結(jié)節(jié)內(nèi)側(cè)突后緣(2具)、跟骨結(jié)節(jié)外側(cè)突(14具)、跟骨前結(jié)節(jié)和內(nèi)外側(cè)突之間(23具),有的甚至出現(xiàn)在跟骨前結(jié)節(jié)足底長韌帶附著處周圍(8具)。跟骨結(jié)節(jié)內(nèi)側(cè)突跖側(cè)面存在一條骨嵴,將跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺分為前后兩部分; 跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺上表面光滑,下表面粗糙。119具跟骨結(jié)節(jié)內(nèi)側(cè)突存在骨刺的標(biāo)本中,左側(cè)跟骨62具、右側(cè)跟骨57具,兩側(cè)跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺的發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.331,P=0.565); 兩側(cè)跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺的長度比較,差異無統(tǒng)計學(xué)意義(Z=-0.396,P=0.692); 跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺寬度(16.42±5.26)mm,其中左側(cè)跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺寬度(15.72±5.43)mm、右側(cè)跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺寬度(17.19±5.02)mm,兩側(cè)跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺寬度比較,差異無統(tǒng)計學(xué)意義(t=-1.533,P=0.128)。589具跟骨標(biāo)本中,230具跟腱止點處存在骨刺,其發(fā)生率高于跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺的發(fā)生率(χ2=50.166,P=0.000)。小趾展神經(jīng)在跟骨底面的行程中伴有相關(guān)的動靜脈,在跟骨底面內(nèi)側(cè)緣轉(zhuǎn)折到跟骨結(jié)節(jié)外側(cè)突之間走行的一段都被緊密的結(jié)締組織和骨性結(jié)構(gòu)包圍。結(jié)論:跟骨骨刺為片狀骨贅,且并非僅發(fā)生在跟骨結(jié)節(jié)內(nèi)側(cè)突; 跟骨結(jié)節(jié)內(nèi)側(cè)突骨刺上下兩個面接觸的軟組織不同,并不是都在跖筋膜里,而應(yīng)該是上面與趾短屈肌接觸,下面與跖筋膜接觸; 小趾展神經(jīng)在跟骨底面內(nèi)側(cè)緣轉(zhuǎn)折到跟骨結(jié)節(jié)外側(cè)突之間走行的一段存在卡壓的解剖學(xué)基礎(chǔ)。
Abstract:
Objective:To explore the anatomical characteristics of calcaneal spurs and distribution of abductor digiti minimi nerve.Methods:Five hundred and eighty-nine dry intact adult cadaveric calcaneus specimens and 10 lower limb specimens(below the mid-segment of cruris)fixed with 10% formaldehyde were selected.The calcaneus specimens were observed carefully and judged whether they had bone spurs.The shape,position and number of bone spurs were recorded,and their lengths and widths were measured.The attachment positions of plantar fascia and flexor digitorum brevis to calcaneus were observed.The lower limb specimens were dissected from dorsum pedis layer by layer,and the abductor digiti minimi nerve and its surrounding structures were isolated and observed.Results:The calcaneus specimens consisted of 293 left calcaneus and 296 right calcaneus.The calcaneus spurs were found at anterior border(119 cases)and posterior border(2 cases)of medial process of calcaneal tuberosity,lateral process of calcaneal tuberosity(14 cases)and anterior tubercle of calcaneus and between medial process and lateral process(23 cases),and some were even found around the adherent positions of long plantar ligament of anterior tubercle of calcaneus(8 cases).A bony crest was found on the plantar side of medial process of calcaneal tuberosity,and it divided the bone spurs on medial process of calcaneal tuberosity into anterior part and posterior part.The upper surface of bone spurs on medial process of calcaneal tuberosity was smooth,while the lower surface was rough.The 119 calcaneus,which had bone spurs on medial process of calcaneal tuberosity,consisted of 62 left calcaneus and 57 right calcaneus,and there was no statistical difference in the incidences of bone spurs on medial process of calcaneal tuberosity between the left calcaneus and the right calcaneus(χ2=0.331,P=0.565).There was no statistical difference in the length of bone spurs on medial process of calcaneal tuberosity between the left calcaneus and the right calcaneus(Z=-0.396,P=0.692).The width of bone spurs on medial process of calcaneal tuberosity was 16.42+/-5.26 mm,and there was no statistical difference in the width of bone spurs on medial process of calcaneal tuberosity between the left calcaneus and the right calcaneus(15.72+/-5.43 vs 17.19+/-5.02 mm,t=-1.533,P=0.128).The bone spurs were found at the ending point of tendo calcaneus in 230 out of 589 calcaneus specimens,and its incidence of bone spurs was higher than that of medial process of calcaneal tuberosity(χ2=50.166,P=0.000).The abductor digiti minimi nerve was companied by related arteries and veins on the undersurface of calcaneus and it was surrounded by dense connective tissues and bony structures in the process of running from medial border of undersurface of calcaneus to lateral process of the calcaneus tuberosity.Conclusion:The calcaneus spur is flaky osteophytes,and it is not only found on the medial process of calcaneal tuberosity.The upper surface and lower surface of bone spur on medial process of calcaneal tuberosity touch different soft tissues,and not always metatarsal fascia.Instead,the upper surface is in contact with flexor digitorum brevis,and the lower surface is in contact with metatarsal fascia.The entrapment syndromes has the anatomical basis for abductor digiti minimi nerve in the process of running from medial border of undersurface of calcaneus to lateral process of calcaneus tuberosity.

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通訊作者:廖立青 E-mail:[email protected](收稿日期:2018-11-01 本文編輯:李曉樂)
更新日期/Last Update: 2019-02-20