Arterial Anatomy of the Tibialis Posterior Tendon
Arterial Anatomy of the Tibialis Posterior Tendon
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胫骨后肌腱的动脉解剖
DOI：
10.1177/1071100714559271
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发表时间：
2015
影响因子：
2.7
通讯作者：
S. Klein
中科院分区：
文献类型：
--
作者：
M. C. Manske;Kathleen E. McKeon;J. Johnson;J. Mccormick;S. Klein
工作背景：胫骨后肌腱功能障碍是一种常见的疾病，可导致疼痛、畸形和残疾，但其发病机制尚不清楚。血管病因已被提出，但存在争议的存在，少血供区，可能使肌腱脆弱。本研究的目的是提供一个描述的动脉供应胫骨后肌腱。方法：60例成人下肢尸体取自一所大学附属的遗体捐献项目。使用死亡后72小时内获得的30份标本进行显微镜分析。先前冷冻了30份标本，并用于肉眼分析。用印度墨水和沃德蓝乳胶注射胫骨前、胫骨后和腓动脉。用次氯酸钠对用于宏观分析的样本进行清创，以暴露腱外解剖结构。对于显微镜分析，使用改良的Spälteholz技术清除肌腱，以暴露腱内血管解剖结构。结果：肉眼观察，平均2.5 ± 0.7条血管进入舟状骨附着点近端的肌腱。总的来说，28/30（93.3%）个标本的血管进入内踝近端4.1 ± 0.6 cm，24/30（80.0%）个标本的血管进入内踝远端1.7 ± 0.9 cm。显微镜下，平均1.9 ± 0.3条血管进入舟骨附着点近端的每个肌腱。总的来说，27/30（90%）个样本的血管进入内踝近端4.8 ± 0.8 cm处的肌腱，30/30（100%）个样本的血管进入内踝远端1.9 ± 0.8 cm处的肌腱。在所有标本中，观察到一个少血供区，开始于内踝近端2.2 ± 0.8 cm，结束于内踝近端0.6 ± 0.6 cm，平均长度为1.5 ± 1.0 cm。显微镜下和肉眼标本上肌腱的附着处血管化良好。结论：胫骨后肌腱由2支血管供应，分别从内踝近端4.5 cm和远端2.0 cm处进入肌腱。观察到踝后血管减少区域。临床相关性：进一步了解胫后肌腱的血管分布可能有助于临床实践，并可能为进一步评估胫后肌腱病变的致病因素提供依据。
Background: Tibialis posterior tendon dysfunction is a common disorder leading to pain, deformity, and disability, although its pathogenesis is unclear. A vascular etiology has been proposed, but there is controversy regarding the existence of a hypovascular region that may render the tendon vulnerable. The purpose of this study was to provide a description of the arterial anatomy supplying the tibialis posterior tendon. Methods: Sixty adult cadaveric lower extremities were obtained from a university-affiliated body donation program. Thirty specimens obtained within 72 hours of death were used for microscopic analysis. Thirty specimens were previously frozen and used for macroscopic analysis. The tibialis anterior, tibialis posterior, and peroneal arteries were injected with India Ink and Ward’s Blue Latex. The specimens used for macroscopic analysis were debrided with sodium hypochlorite to expose the extratendinous anatomy. For the microscopic analysis, the tendon was cleared using a modified Spälteholz technique to expose the intratendinous vascular anatomy. Results: Macroscopically, an average of 2.5 ± 0.7 vessels entered the tendon proximal to the navicular insertion. In all, 28/30 (93.3%) specimens had a vessel entering 4.1 ± 0.6 cm proximal to the medial malleolus and 24/30 (80.0%) specimens had a vessel entering 1.7 ± 0.9 cm distal to the medial malleolus. Microscopically, an average of 1.9 ± 0.3 vessels entered each tendon proximal to the navicular insertion. In total, 27/30 (90%) specimens had a vessel entering the tendon 4.8 ± 0.8 cm proximal to the medial malleolus and 30/30 (100%) specimens had a vessel entering the tendon 1.9 ± 0.8 cm distal to the medial malleolus. In all specimens, a hypovascular region was observed, starting 2.2 ± 0.8 cm proximal to the medial malleolus and ending 0.6 ± 0.6 cm proximal to the medial malleolus with an average length of 1.5 ± 1.0 cm. The insertion of the tendon was well vascularized both on microscopic and macroscopic specimens. Conclusion: The tibialis posterior tendon was supplied by 2 vessels entering the tendon approximately 4.5 cm proximal and 2.0 cm distal to the medial malleolus. A retromalleolar hypovascular region was observed. Clinical Relevance: Improved understanding of the vascularity of the tibialis posterior tendon may be helpful in clinical practice and potentially provides a basis for further evaluation of the causative factors of tibialis posterior tendinopathy.