距腓前韧带的解剖与MRI软组织专辑
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文章来源｜「山东足踝」公众号
各位读者，大家好！
近期，我们将制作一期来源于「河南足踝」和「山东足踝」的软组织专辑，该专辑由郑州市骨科医院的王翔宇教授团队和山东大学第二医院的胡勇教授团队，从多年临床诊疗和经验积累出发，针对足踝部软组织的临床解剖、影像检查等基础知识、软组织病损的临床诊断和治疗、手术治疗中的术式及其组合应用等，以及临床典型病例分别进行分享。
今天，由山东大学第二医院的胡勇教授团队为大家带来的「距腓前韧带的解剖与MRI」。
lighter是什么意思
本文通过回顾多篇文献，探讨了距腓前韧带(ATFL)的解剖与MRI。
作者导读
▶ 如何在MRI上准确地找到外侧副韧带（主要是ATFL），有哪些可参照的标志？
哈利波特英文版下载
areyourious● 距骨断层形态
● 层数
● 以距腓后韧带(PTFL)作为标记
▶ 当找不到ATFL的时候，会不会是因为MRI没有扫到？
▶ 可以在两个层面看到ATFL？
▶ MRI所见ATFL病变的准确性是怎样的？
一、距腓前韧带的解剖与MRI
披头士乐队经典歌曲01
解剖
▲Fig. 1.aghast Osteoarticular anatomical disction of theligaments of the foot and ankle joint (Lateral view). (1)Fibula and lateral malleolus. (2) Tibia. (3) Anterior tibiofibular ligament. (3'). Distal fascicle of the anterior tibiofibular ligament. (4) Anterior talofibular ligament. (5)
Calcaneofibular ligament. (6) Lateral talocalcaneal ligament. (7) Talocalcaneal interosous ligament and sinustarsi. (8) Cervical ligament. (9) Dorsolateral calcaneocuboid ligament. (10) Dorsal talonavicular ligament.(11) Calcaneonavicular fascicle of Chopart ligament.(12) Dorsal cuneonavicular ligament. (13) Calcanealbursa. (14) Calcaneal tendon (cut). [Color figure can beviewed in the online issue, which is available at www.]
▲Fig. 2. Osteoarticular anatomical disction of theligaments of the foot and ankle joint (Lateral view). (1)Lateral malleolus (tip). (2) Tibia. (3) Anterior tibiofibularligament. (3') Distal fascicle of the anterior tibiofibularligament. (4) Anterior talofibular ligament. (5) Calcaneofibular ligament. (6) Lateral talocalcaneal ligament. (7)Talocalcaneal interosous ligament and sinus tarsi. (8)Cervical ligament. (9) Dorsolateral calcaneocuboidligament. (10) Calcaneonavicular fascicle of Chopartligament. [Color figure can be viewed in the online issue,which is available at www.]
▲Fig. 3. Osteoarticular anatomical disction of theligaments of the foot and ankle joint (Anterior view). (1)Lateral malleolus. (2) Tibia. (3) Anterior tibiofibular ligament. (3') Distal fascicle of the anterior tibiofibular ligament. (4) Interosous membrana. (5) Anterior talofibular ligament. (5) Calcaneofibular ligament. (6) Anteriorarticular surface of the talus. (7) Medial malleolus. (8)Medial collateral ligament. (9) Dorsal talonavicular ligament. [Color figure can be viewed in the online issue,which is available at www.]
02
参照标志
如何在MRI上准确地找到外侧副韧带（主要是ATFL），有哪些可参照的标志？
▶ 距骨断层形态
一般距腓前韧带出现在距骨颈层面，相较于距腓后韧带的宽大扇形（在水平面的MRI影像中表现），距腓前韧带比较细长。
● ATFL
The center is an average 10.1mm proximal to the tip of the fibula as measured along the axis of the fibula.
● PTFL
粤语词典The fibula attachment is centered an average 9.7mm proximal to the distal tip in the malleolar fossa.
casualty▶ 断层层数
成人高考高升本在断层的MRI中，水平面，沿外踝尖向近端数3~4个层面，即可找到距腓前韧带。（按层厚3mm计）
▲Fig. 1. Measurement parameters for the anterior talofibular ligament.Line AB width of the anterior talofibular ligament at the fibulaattachment; Line AC perpendicular distance from the anteriortalofibular ligament to the fibula tip; Line AD anteroposterior widthof distal fibula at the anterior talofibular ligament attachment.
▶ 踝中立位时扫描
▲Fig. 4 Diagrammatic reprentation of the angles among the anteriortalofibular ligament (ATFL), calcaneofibular ligament (CFL) and longaxis of the fibula (F)
The PTFL is a very strong ligament and passalmost horizontally from a groove at the medial faceposterior to articular surface of the lateral malleolusto the lateral and posterior aspects of the talus.
距腓前后韧带基本与胫腓长轴呈直角，即踝中立位时扫描，水平面上恰好能看到距腓前后韧带的全长。
跟腓韧带与胫骨长轴远端向后夹16~22°，即踝关节在背伸20°时进行扫描，即可在矢状面及冠状面上看到跟腓韧带的全长。踝关节中立位时进行扫描，可在水平面上看到部分跟腓韧带。
▶ 在出现PTFL层面找ATFL
距腓后韧带出现的层面上寻找距腓前韧带是一个比较快捷的方式。因为距腓后韧带较宽大，且不易损伤断裂。
二、常见问题
01. 当找不到ATFL的时候，会不会是因为MRI没有扫到？
▲Table 1 Comparing the measurements of width and length of ATFL and CFL
▲Table 2 Dimensions of the lateral ankle ligaments (mm)
距腓前韧带的宽度在7~11mm左右，按MRI层厚3mm计，一般不会出现——因没扫到而找不到的情况（当韧带正常时），也即如在MRI上找不到，则高度怀疑断裂。
02. 可以在两个层面看到ATFL？
因距腓前韧带厚6~10mm，所以可能在两个层面都看到。
03.first name是什么意思 MRI所见ATFL病变的准确性是怎样的？
▲Table 3 Validity of MRI (%) in the diagnosis of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) lesions.
▲Figure 2 Images of a 30-year-old man with chronic ankle instability.Axial, proton density image (2000 ms TR/15 ms TE) shows abruptdiscontinuation of the ATFL (arrow). The radiological diagnosis wasa complete tear of the ligament, but a partial tear of the ligament wasnoted at surgery
▲Figure 4 Images of a 19-year-old woman with chronic ankle pain.Axial, proton density image (2000 ms TR/15 ms TE) shows partialdiscontinuation of the ATFL (arrow). Radiological diagnosis showeda partial tear of the ligament, but a complete tear of the ligament wasnoted at surgery.
MRI可能存在假阳性及假阴性，即MRI的结果与手术探查结果可能不一致。
参考文献：
1、Van den Bekerom, M. P. J., Oostra, R. J., Alvarez, P. G., & van Dijk, C. N. (2008). The
anatomy in relation to injury of the lateral collateral ligaments of the ankle: A current concepts review. Clinical Anatomy, 21(7), 619–626. doi:10.1002/ca.20703
