Functional anatomy of the Achilles tendon
Functional anatomy of the Achilles tendon
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DOI：
10.1007/s00167-010-1083-7
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发表时间：
2010-05-01
影响因子：
3.8
通讯作者：
Maffulli, Nicola
中科院分区：
文献类型：
--
作者：
Doral, Mahmut Nedim;Alam, Mahbub;Maffulli, Nicola
跟腱是人体内最强壮、最粗的肌腱。这也是最常见的肌腱断裂。它始于小腿中部附近，是腓肠肌和比目鱼肌的联合肌腱。这两块肌肉对肌腱的相对贡献是不同的。肌腱纤维的螺旋化产生了集中应力的区域，并赋予了机械优势。跟骨植入是专门设计的，旨在帮助从肌腱到跟骨的应力消散。附着体呈新月形，有明显的内侧和外侧突出。肌腱的血供来自肌腱连接处、周围结缔组织中的血管和骨腱连接处。血管区域可简单地分为三部分，中段由腓动脉供血，近端和远端由胫后动脉供血。这在肌腱的中段留下了一个相对较少的血管区域，也就是大多数问题发生的地方。跟腱的神经支配来自腓肠神经，而来自胫神经的供应较少。肌腱细胞产生I型胶原，构成正常肌腱90%的细胞成分。有证据表明，断裂或病理的肌腱会产生更多的III型胶原，这可能会影响肌腱的抗拉强度。对力量的直接测量显示，在跑步过程中，跟腱的负荷高达9kN，相当于体重的12.5倍。
The Achilles tendon is the strongest and thickest tendon in the human body. It is also the commonest tendon to rupture. It begins near the middle of the calf and is the conjoint tendon of the gastrocnemius and soleus muscles. The relative contribution of the two muscles to the tendon varies. Spiralisation of the fibres of the tendon produces an area of concentrated stress and confers a mechanical advantage. The calcaneal insertion is specialised and designed to aid the dissipation of stress from the tendon to the calcaneum. The insertion is crescent shaped and has significant medial and lateral projections. The blood supply of the tendon is from the musculotendinous junction, vessels in surrounding connective tissue and the osteotendinous junction. The vascular territories can be classified simply in three, with the midsection supplied by the peroneal artery, and the proximal and distal sections supplied by the posterior tibial artery. This leaves a relatively hypovascular area in the mid-portion of the tendon where most problems occur. The Achilles tendon derives its innervation from the sural nerve with a smaller supply from the tibial nerve. Tenocytes produce type I collagen and form 90% of the cellular component of the normal tendon. Evidence suggests ruptured or pathological tendon produce more type III collagen, which may affect the tensile strength of the tendon. Direct measurements of forces reveal loading in the Achilles tendon as high as 9 KN during running, which is up to 12.5 times body weight.