小腿外侧肌肉通常只有腓骨长肌(fibularis longus muscle,FLM)与腓骨短肌(fibularis brevis muscle,FBM)两块,部分存在第三、第四腓骨肌变异。
腓骨长肌起自腓骨头、腓骨上2/3的外侧面和小腿深筋膜,肌束向下移行长的肌腱,经外踝后方、跟骨外侧面及腓骨肌下支持带转至足底,止于内侧楔骨和第1跖骨基底部。腓骨短肌起于腓骨下1/3外侧,与腓骨长肌行于同一腱鞘,止于第5跖骨基底部。
腓骨短肌在第5跖骨基底部的止点存在诸多变异,对第5跖骨基底部骨折的入路与手术固定至关重要。对此,国外学者通过对102具尸体解剖,总结出腓骨短肌腱止点规律,并进行分型。
依据腓骨短肌腱以单束或多束附着,分为两型,两型又分为3亚型。
I型:单束附着。腓骨短肌腱以单束附着与第5跖骨基底粗隆部外侧。此型占70.6%。
Type I:single distal attachment. The tendon inserts into the tuberosity at the base of the fifth metatarsal bone, on its lateral side. This type was present in 72 cases (70.6%)。
II型:多束附着。主体仍附着于第5跖骨基底粗隆部外侧。此型占29.4%,分如下3亚型:
Type II: Bifurcated distal attachment. The main tendon inserts to into the tuberosity at the base of the fifth metatarsal bone, on its lateral side. This type was observed in 30 lower limbs (29.4%).
IIa:分束止于第5跖骨基底背侧,部分与第三腓骨肌联结。
Subtype a: the accessory band inserts to the dorsal surface of the base of the fifth metatarsal. At the attachment point, the FBT connects to part of the fibularis tertius tendon. This subtype was observed in 23 cases.
IIb:分束分成内侧束和外侧束。外侧束止于第5跖骨基底部背侧,内侧束(强束)止于第5跖骨干部。
Subtype b: the accessory band splits into a medial and a lateral band. The lateral band inserts to the dorsal surface of the base of the fifth metatarsal bone, while the medial band (stronger) inserts to the middle part of the shaft of the fifth metatarsal bone. This type was present in five cases.
IIc:分束分成内侧束和外侧束。外侧束止于第5跖骨基底背侧,内侧束与第3腓骨肌联结,形成第4骨间背侧肌。
Subtype c: the accessory band splits into a medial and a lateral band. The lateral band inserts to the dorsal surface of the base of the fifth metatarsal bone, while the medial band creates a fusion with the tertius fibularis. This fusion gives rise to the fourth interosseus dorsalis muscle. This type was observed in two feet.
钢板的6大功能
TFCC损伤分型与MR表现
阻挡钉(Poller钉)怎么打?
“漂浮锁骨”:少见病例报告汇总
警惕这11种“小骨折”,可能提示大问题!
第一掌骨基底部骨折分类、诊断与治疗
多图详解WALANT技术在手、掌部骨折中的应用
一种直接显露“三踝(前踝、外踝、后踝)”的手术入路
总结!一文掌握小腿四大骨筋膜室的边界与内容,速读!
92.1G超清!AO配套视频——骨折各论,限时免费领取!
合并结节骨折的肩关节脱位,在急诊室直接复位安全吗?
40张图,带你了解40种特殊类型骨折(四肢篇)
中英文文献全文下载方法大全!你都会了吗?
多图详解|足部骨性解剖与常见副骨
“四踝”骨折的内固定方式与固定顺序
关节积脂血症(lipohemarthrosis)
桡骨头“安全区”
.....