| Background:With the advancement in micro-technology, There have been some breakthroughs in all kinds of the medicine field. Medial ankle ligament injury has been a problem in sports medicine, the presence of the medial ankle ligament damage in patients with fractures of the lateral malleolus is at least 40%.of which occur in patients with persistent pain and late ankle deformation However, the presence of medial ankle ligament anatomy is dispute, the higher of the rate about clinical misdiagnosis, scholars both at home and abroad to the specific treatment methods and ideas are different. Medial ankle ligament damage in acute ankle trauma accounts for about 15%, the medial ankle ligament injury alone is less, often complex and the presence of lateral malleolus fracture syndesmosis ligament complex. Looking at the research advances ankle ligament on the inside, for the specific anatomy, diagnostic methods and treatment of specific injury are controversial. Medical students must have a full understanding of every movement of medial of the ankle ligaments. If handled um-properly, It can occur ankle instability, even cause arthritis later. And if clinicians lack of specific to it, he or she have difficult to fully grasp its diagnosis and treatment to patients with unseen risks to some extent. It is be necessary to have a understanding to the local anatomy, describe their morphology and to analyze the role of the medial ankle ligament function in which each part plays. For medial ankle ligament specific components, there is variation and separation yet to reach a common understanding. However, there may be a key to discover medial about ankle ligament damage. When running the ground, down the stairs and high-speed change of direction, It is easily prone to acute ankle injuries, because the ankle in plantar flexion position, while also being a result of the violence deformation foot rotated within severe ankle deformation or cause violence or spin, or even possible fracture. To grasp a fully understand the complex of ankle medial ligament injury mechanism is a foundation for us. Chronic ankle injury is usually caused by the loss of function of the posterior tibia tendon, sports complex injury or ankle arthroplasty.The diagnostic methods of the medial ankle ligament damage vary, ankle medial ligament damage in his body when the investigation medial swelling significantly, subcutaneous ecchymosis, deformation stress when the pain got worse. Checking vital signs, It can be the first instinct that indicate medial ankle ligament injury. Clinical examination method for medial ligament superficial examination similar to the drawer test, the patient sitting and remain mild ankle plantar flexion, the examiner handedly stable tibia position, the other hand holding the affected foot heel and push forward, when the inside of patients when shallow ligament damage, and contra-lateral comparison, larger talus deformation angle, Deep medial ligament injury can be manifested as increased shift talus.At the same time, because of the deep medial ligament tibia joint participation with restrictions on the ankle eversion. so deformation test also reflects to some extent the case of the deep medial ligament, but its reliability is relatively low. Many scholars stress position under X-ray ankle medial gap (MCS) as a diagnostic medial ligament rupture of a basis, but the high false-positive rate of the method of diagnosis. MRI examination can show changes effective soft tissue structures such as ligaments, but the disadvantage is more difficult to spread. CT scan can be used to fully assess the situation ankle fracture surface of the ligaments and other soft tissues can not be displayed. The X-ray examination to determine possible preliminary medial ankle ligament damage due to the limited experience of the doctor, not fully, so take advantage of simple routine X-ray examination has been discussed is the problem.Therefore, this issue of the corpse by gross anatomy of the foot specimens were observed and all of its components composed of the beginning and ending of length, width and thickness of the portion of the sample group. Biomechanical study simulated ankle injury in the initial position and varying degrees of injury time to analyze the medial ankle ligament injuries in the complex mechanisms of the work. Finally Retrospective analysis medial ankle ligament space (MCS) and the medial ankle ligament damage correlation comprehensive discussion medial ankle ligament Based on the above three aspects in maintaining the stability of the medial ankle important role further understanding of the medial ankle ligament, has some significance for biomechanical research and clinical work.Objectives:1. Anatomy of the components and the adjacent medial ankle ligaments, analyze some of the characteristics and functions of the various components and their relationships.2. Compare the value of the medial clear space (MCS) of the ankle with the "gold standard" MRI, thus provide a more reliable threshold values for the initial diagnosis of clinical medial ankle ligament damage.3. Line by biomechanical studies to further explore the inside of the ankle ligaments intact group, the role of the medial ankle stability among the three groups shallow fracture group and complete rupture group.Methods:1. The local anatomical medial ankle ligamentsSelect formalin solution immersion adult male calf-ankle specimens eight cases, layer by layer after Anatomic ankle medial ligament bundle number and composition of layers, out of shape and distribution of the starting and ending with an accuracy of 0.02mm caliper measurement of ankle respectively medial ligament length, width and thickness were measured three times and averaged.2. Biomechanical studies medial ankle ligament damage in different degrees and different initial stress positionsThe anatomy of the leg-ankle eight cases were divided into medial ankle ligament intact group, shallow fracture group and complete rupture group, use BOSE mechanics of materials testing machine (ELF-3510AT, Bose, Inc, USA), a digital electronic pressure sensor (Tek-scan, Inc, Boston, MA) and pressure sensitive film technology (K-scan 6900, Tek-scan, Inc, USA) respectively, in different locations ankle biomechanical test, The initial position (neutral position 0 °, plantar flexion 30 °, dorsal flexion 20 °) and medial ankle ligament damage in different situations (complete set, shallow fracture group, complete rupture group) tibia different measuring ankle joint contact area from dynamic changes stress distribution, the use of statistical software SPSS 13.0 and repeated measures analysis of variance on the data collected statistics to P<0.05as statistically significant standard. To analyze the position of the injured ankle initial medial ankle ligament injury complexity, to further explore the inside of the ankle ligament layers of difference between the maintenance of stability.3. The conventional X-ray examination medial ankle gap (MCS) in the clinical application of diagnostic medial ankle ligament injuryBy Retrospective studies to MRI, the "gold standard", ankle medial gap contrast observations (MCS) value, the SPSS statistical software, and receiver operating characteristic (ROC curve) analysis, preliminary clinical diagnosis of ankle medial ligament damage in varying degrees to provide a more reliable MCS critical value, provide guidance for clinical medial ankle ligament injury diagnosis and treatment.Results:1. Medial ankle ligament oblique flexor support belt cover, walking through the posterior tibia tendon medial ankle ligament, the rear. According to its starting and ending points to take shape and shallow and deep layers, layer by layer from the front to the rear side of the shallow anatomical structure across the ankle and subtalar joints, including:tibionavicular ligament, tibia spring ligament (ligament tibial jump), with ligament and tibia from the superficial posterior tibia ligament. Just across the ankle deep structure, including:the anterior tibia from ligament tibia ligament from the deep. Because the superficial ligament and joint capsule close.It is difficult completely separated. Tibionavicular ligament medial ligament is longest. And the length is 18.22～26.14mm. The tibia with ligament from the medial malleolus is from the inside surface of the front mound from the sudden stop at the calcaneus load, with the plantar side of the boat and the scaphoid ligament. Starting in the spring ligament tibia malleolus of the hill side, located tibia ligament with the ligament between the tibia boat, vertical downward beyond the plantar surface of the spring ligament. Ligament and tibia and tibia with tow boat ligament in close proximity, difficult dissection. Distance from the posterior tibia ligament in the medial malleolus mound shallow ditch, posterior oblique medial talar surface beyond rear ends. The ligament bundle shorter length 8.32～13.52mm; deep structural features included in the tibialis anterior and posterior tibia ligament away from the deep ligament. The former starts from the inside before malleolus, tibia near the starting point of the spring ligament, ligaments beyond the downstream ends back of the neck of the talus, tibia with partial ligament fibers and blend, slightly fan-shaped distribution. Shallow is the posterior tibia tendon sheath, deep to the joint capsule, the more close, the ligament beam length 11.32～15.62mm. The latter is located on the rear from the inner surface of the tibia ligament shallow, superficial posterior tibia ligament from the starting and ending point is similar, just across the ankle. The ligament is composed ligament bundle widest, most thick, a width of 6.72～9.84mm, a thickness of 1.72～2.24mm.2.The ankle in different positions (0 ° neutral position, plantar flexion 30 °, dorsal flexion 20 °) and medial ankle ligament injury under different degrees (full set, shallow fracture group, complete rupture group), the pressure-sensitive slice technique measured the total area of the tibia from the joint contact, there are differences between different peak stress and stress distribution. Specific performance:a neutral position 0 ° and 20 ° dorsal flexion, the total area of the tibia from the joint contact between different medial ankle ligament injury group were not significantly different, And at 30 ° plantar flexion position, there is a significant difference (P<0.05) between the inside of the ankle ligament damage in different groups. With the load carried, and the dynamic performance of tibiotalar joint contact surface compressive stress and peak between three different groups gradually increased damage, manifested as darker regions, the central region of the displacement and the compressive stress and the like. And at 30 ° plantar flexion position, there is a significant difference (P<0.05) between the inside of the ankle ligament damage in different groups. With the load carried, and the dynamic performance of tibiotalar joint contact surface compressive stress and peak between three different groups gradually increased damage, manifested as darker regions, the central region of the displacement and the compressive stress and the like.3, The MRI examination medial ankle ligament injury interrupts the continuity of the performance of the ligament, ligament laxity, such as wavy lines change, abnormal high signal simultaneously ligament, often accompanied by bone fracture or tear fluid and articular capsule soft tissue swelling. In MRI, the "gold standard", the statistical ROC curve analysis to know:medial ankle ligament complete rupture (including deep fracture, and shallow and deep at the same time breaking in both cases) MCS optimal critical value 5.80mm, the diagnosis of medial ankle ligament rupture shallow optimal threshold value of MCS 4.50mm.Conclusions:1, Ankle medial ligament anatomy can be divided into deep and shallow layers, each component adapted to its function, can effectively maintain the stability of the inside of the ankle joint.2, The ankle joint at a different location, medial ankle ligament varying degrees of damage differ its function. Ankle plantar flexion 30 ° position, the differences between the three groups medial ankle ligament damage in varying degrees.3, MRI, as the "gold standard" to the inside of the ankle joint gap value (MCS) can more accurately predict the medial ankle ligament damage in varying degrees, to lay the foundation for the initial diagnosis. |
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