The blood supply of the posterior tibial tendon
The blood supply of the posterior tibial tendon
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DOI：
10.1302/0301-620x.84b1.11592
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发表时间：
2002-01-01
影响因子：
--
通讯作者：
Tillmann, B
中科院分区：
文献类型：
--
作者：
Petersen, W;Hohmann, G;Tillmann, B
我们用注射技术和免疫化学方法研究了人胫骨后肌腱的血管分布。本文报道了用~（99）Tc-明胶墨汁注射法测定胫后肌腱血管内容积的新方法。用γ井计数器测量了人胫后肌腱不同部位的三个1cm长的节段，其主要血供来自胫后动脉。血管从后方经腱系膜进入胫后肌腱腱旁。从腱旁开始，血管穿过胫后肌腱，并在腱内形成纵向的血管网。肌腱实质中的血管数量始终少于周围腱旁的血管数量。胫后肌腱内血管分布不均匀。在踝后区，血管内容积显著减少，平均值为15穆尔/g肌腱组织。近端和远端区域的平均血管内容积之间无显著差异（远端，27.7穆尔/g肌腱组织;近端，30穆尔/g肌腱组织）。免疫组化结果显示，层粘连蛋白在内踝后肌腱前部无免疫组化染色。胫后肌腱断裂最常见的部位是内踝后。一个潜在的内源性风险因素可能是无血管组织的愈合潜力有限。
W e studied the vascular pattern of human posterior tibial tendons by injection techniques and immunohistochemically using antibodies against laminin. The intravascular volume of the posterior tibial tendon was determined using a new method of injection of a solution of Tc-99m and gelatin ink into the lower legs of cadavers. Three segments of 1 cm length from different regions of the human posterior tibial tendon were measured using a gamma well counter.The main blood supply arises from the posterior tibial artery. Blood vessels enter the paratenon of the posterior tibial tendon via a mesotenon from the posterior aspect. From the paratenon, the blood vessels penetrate the posterior tibial tendon and anastomose with a longitudinally orientated intratendinous network. The number of vessels in the substance of the tendon is consistently less than that in the surrounding paratenon. The distribution of blood vessels within the posterior tibial tendon is not homogeneous. In the retromalleolar region the intravascular volume was significantly reduced with a mean value of 15 mul/g of tendon tissue. There was no significant difference between the mean intravascular volumes of the proximal and distal areas (distal, 27.7 mul/g tendon tissue; proximal, 30 mul/g tendon tissue). The immunohistochemical investigation showed that there was no immunostaining for laminin in the anterior part of the tendon in the region where it passes behind the medial malleolus. This region is avascular.The most frequent site of rupture of the posterior tibial tendon is in the region behind the medial malleolus. A potential endogenous risk factor may be the limited healing potential of avascular tissue.