Major change in morphology of the talofibular ligaments during fetal development and growth
Major change in morphology of the talofibular ligaments during fetal development and growth
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DOI：
10.1007/s00276-022-02987-8
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发表时间：
2022-07-20
影响因子：
1.4
通讯作者：
Abe, Hiroshi
中科院分区：
文献类型：
--
作者：
Kim, Ji Hyun;Jin, Zhe-Wu;Abe, Hiroshi
背景和目的踝关节扭伤通常是由于距腓骨前后韧带（ATFL， PTFL）损伤引起的。我们比较了这些韧带在不同胎龄胎儿（GAs）的形态与成人的水平配置。材料与方法对22例胎儿（9 ~ 12周10例，26 ~ 39周12例）单侧踝关节进行组织学检查。结果在GA 9 ~ 10周时，ATFL和PTFL由水平运行的直纤维组成。尽管最初的PTFL远离距踝关节，但最初的ATFL表现为距踝关节囊增厚。直到12周的GA，距骨和腓骨被一个扩大的关节腔分开。因此，最初的水平韧带在远端方向被“拉扯”。韧带的远端部分由薄的胶原纤维组成，排列不规则，而短的近端部分有厚的纤维和水平排列。在近期胎儿中，韧带不含水平纤维。ATFL在厚滑膜褶周围呈波浪形，并在整个过程中暴露于关节腔；远端较近端薄。PTFL体积庞大，由不规则排列的纤维组成。因此，近期胎儿的形态与成人有很大的不同。结论成人踝关节横、直复合纤维明显是由出生后重建所致，并有不同的力学需求。
Background and purpose Ankle sprain is often attributed to damage of the anterior and posterior talofibular ligaments (ATFL, PTFL). We compared the morphology of these ligaments in fetuses of different gestational ages (GAs) with the horizontal configuration in adults. Materials and methods Histological sections of unilateral ankles were examined in 22 fetuses, 10 at GA of 9-12 weeks and 12 at GA of 26-39 weeks. Results At a GA of 9 to 10 weeks, the ATFL and PTFL consisted of horizontally running straight fibers. The initial ATFL appeared as a thickening of the capsule of the talocrural joint, although the initial PTFL was distant from this joint. Until a GA of 12 weeks, the talus and fibula were separated by an expanding joint cavity. Thus, the initial horizontal ligaments were "pulled" in a distal direction. The distal parts of the ligaments consisted of thin collagenous fibers that had an irregular array, whereas the short proximal parts had thick fibers and a horizontal array. In near-term fetuses, the ligaments contained no horizontal fibers. The ATFL had a wavy course around the thick synovial fold, and was exposed to the joint cavity along the entire course; the distal part was thinner than the proximal part. The PTFL was bulky and consisted of fibers with an irregular array. Therefore, the morphology in a near-term fetus was quite different from that in adults. Conclusion The horizontal and straight composite ankle fibers in adults apparently result from postnatal reconstruction, depending on mechanical demand.