Ankle Anatomy

踝關節(jié)解剖

A Patient’s Guide to Ankle Anatomy

患者指南：踝關節(jié)解剖

Introduction

簡介

The ankle joint acts like a hinge. But it’s much more than a simple hinge joint. The ankle is actually made up of several important structures. The unique design of the ankle makes it a very stable joint. This joint has to be stable in order to withstand 1.5 times your body weight when you walk and up to eight times your body weight when you run.

   踝關節(jié)就像一個鉸鏈，但又不僅僅是一個簡單的鉸鏈關節(jié),。踝關節(jié)實際上是由幾個重要的結構組成的,。踝關節(jié)的獨特結構特點使其成為一個非常穩(wěn)定的關節(jié)。該關節(jié)在你步行時必須承受1.5倍體重的負荷,，跑步時則需要承受8倍體重的負荷,。

Normal ankle function is needed to walk with a smooth and nearly effortless gait. The muscles, tendons, and ligaments that support the ankle joint work together to propel the body. Conditions that disturb the normal way the ankle works can make it difficult to do your activities without pain or problems.

   為了能夠以平穩(wěn)而幾乎毫不費力的步態(tài)行走，正常功能的踝關節(jié)則是必要條件,。肌肉,、肌腱及韌帶有機結合并組成踝關節(jié)，從而起到推動身體前行的作用,。一旦有任何影響踝關節(jié)正常運作的因素存在,，那么很難避免在相關活動時出現(xiàn)踝關節(jié)疼痛或者其他問題。

This guide will help you understand

該指南有助于你理解

•  what parts make up the ankle

•  how the ankle works

• 踝關節(jié)的組成

• 踝關節(jié)的功能

Important Structures

重要結構

The important structures of the ankle can be divided into several categories. These include

   踝關節(jié)的重要結構分為若干個部分,。包括：

• bones and joints

• ligaments and tendons

• muscles

• nerves

• blood vessels

• 骨與關節(jié)

• 韌帶和肌腱

• 肌肉

• 神經

• 血管

The top of the foot is referred to as the dorsal surface. The sole of the foot is the plantar surface.

   腳的頂部被稱為足背面,，腳底為足底面。

Bones and Joints

骨與關節(jié)

The ankle joint is formed by the connection of three bones. The ankle bone is called the talus. The top of the talus fits inside a socket that is formed by the lower end of the tibia(shinbone) and the fibula (the small bone of the lower leg). The bottom of the talus sits on the heel bone, called the calcaneus.

   踝關節(jié)是由三塊骨頭連接形成,?！磅坠恰狈Q為距骨。距骨的頂部嵌入于由脛骨和腓骨的遠端所形成的凹穴樣結構,。距骨底部則位于跟骨之上,。

The talus works like a inside the socket to allow your foot to move up (dorsiflexion) and down (plantarflexion).

   距骨在凹穴內活動時，你的腳就在向上（背屈）或者向下（跖屈）運動了,。

Woodworkers and craftsmen are familiar with the design of the ankle joint. They use a similar construction, called a mortise and tenon, to create stable structures. They routinely use it to make strong and sturdy items, such as furniture and buildings.

   木匠和工匠似乎很熟悉踝關節(jié)的構造,。他們利用類似的結構，稱為榫卯,，用以創(chuàng)造穩(wěn)定的結構,。他們經常應用它來制作牢固而結實的物品，例如家具和建筑物,。

Inside the joint, the bones are covered with a slick material called articular cartilage. Articular cartilage is the material that allows the bones to move smoothly against one another in the joints of the body.

   在關節(jié)內部,，骨骼都被一種稱為關節(jié)軟骨的光滑組織覆蓋著。由于關節(jié)軟骨的存在,，關節(jié)內相鄰骨骼之間能夠平滑地移動,。

The cartilage lining is about one-quarter of an inch thick in most joints that carry body weight, such as the ankle, hip, or knee. It is soft enough to allow for shock absorption but tough enough to last a lifetime, as long as it is not injured.

   絕大多數(shù)承重關節(jié)的軟骨約有四分之一英寸厚，如踝關節(jié),，髖關節(jié),，膝關節(jié)。由于它足夠柔軟,，可以很好地起到緩沖震蕩的作用,，同時又足夠堅韌，在不受損傷的前提下,，可一生受用,。

Ligaments and Tendons

韌帶和肌腱

Ligaments are the soft tissues that attach bones to bones. Ligaments are very similar to tendons. The difference is that tendons attach muscles to bones. Both of these structures are made up of small fibers of a material called collagen. The collagen fibers are bundled together to form a rope-like structure. Ligaments and tendons come in many different sizes and like rope, are made up of many smaller fibers. Thickness of the ligament or tendon determines its strength.

   韌帶是連接骨頭與骨頭的軟組織。韌帶與肌腱十分類似,。所不同的是,，肌腱連接肌肉與骨骼。這兩種結構都是由一種稱為膠原的小纖維構成的,。許許多多的膠原纖維成束狀結合在一起,，形成了繩索狀的結構。許多小纖維束構成了許多不同大小的繩索樣的韌帶和肌腱,。韌帶或肌腱的厚度決定其強度,。

Ligaments on both sides of the ankle joint help hold the bones together. Three ligaments make up the lateral ligament complex on the side of the ankle farthest from the other ankle. (Lateral means further away from the center of the body.) These include the anterior talofibular ligament (ATFL), the calcaneofibular ligament(CFL), and the posterior talofibular ligament (PTFL). A thick ligament, called the deltoid ligament, supports the medial ankle (the side closest to your other ankle).

   踝關節(jié)兩側的韌帶有助于維持骨骼之間的連接。踝關節(jié)外側韌帶復合體由三個韌帶組成,，該復合體位于該腳踝距離另一個腳踝最遠的那一側,。（外側意味著離身體的中心更遠）。該復合體包括距腓前韌帶（ATFL）,，跟腓韌帶（CFL）,，和距腓后韌帶（PTFL）。一條被稱為三角韌帶的厚韌帶,，則維持腳踝內側面（最接近你另一個腳踝的那一側）,。

Ligaments also support the lower end of the leg where it forms a hinge for the ankle. This series of ligaments supports the ankle syndesmosis, the part of the ankle where the bottom end of the fibula meets the tibia. Three main ligaments support this area. The ligament crossing just above the front of the ankle and connecting the tibia to the fibula is called the anterior inferior tibiofibular ligament (AITFL). The posterior fibular ligaments attach across the back of the tibia and fibula. These ligaments include the posterior inferior tibiofibular ligament (PITFL) and the transverse ligament. The interosseous ligament lies between the tibia and fibula. (Interosseous means between bones.) The interosseus ligament is a long sheet of connective tissue that connects the entire length of the tibia and fibula, from the knee to the ankle.

  在下肢遠端形成踝關節(jié)鉸鏈結構時，韌帶也起到了支持作用,。有一系列韌帶保護踝部的下脛腓聯(lián)合,，即踝關節(jié)中脛骨遠端與腓骨遠端相接觸的那一部分。有三個主要的韌帶維持這一部位,。其中,，走行于踝前上部，連接脛,、腓骨的韌帶,，被稱為下脛腓前韌帶（AITFL）。腓骨后韌帶附著于脛骨和腓骨的背面,。這些韌帶包括下脛腓后韌帶（PITFL）和橫韌帶,。骨間韌帶位于脛骨和腓骨之間。從膝關節(jié)到踝關節(jié)，骨間韌帶是連接脛骨和腓骨全長的一長片狀的結締組織,。

The ligaments that surround the ankle joint help form part of the joint capsule. A joint capsule is a watertight sac that forms around all joints. It is made up of the ligaments around the joint and the soft tissues between the ligaments that fill in the gaps and form the sac.

   包繞踝關節(jié)的韌帶參與組成了關節(jié)囊的一部分,。關節(jié)囊是包繞整個關節(jié)的封閉式囊狀結構。它是由關節(jié)周圍韌帶和用于填補韌帶之間間隙的軟組織組成的,。

The ankle joint is also supported by nearby tendons. The large Achilles tendon is the most important tendon for walking, running, and jumping. It attaches the calf muscles to the calcaneus (heelbone) and allows us to raise up on our toes. The posterior tibial tendon attaches one of the smaller muscles of the calf to the underside of the foot. This tendon helps support the arch and allows us to turn the foot inward. The anterior tibial tendon allows us to raise the foot. Two tendons run behind the outer bump of the ankle (the lateral malleolus). These two tendons, called the peroeals, help turn the foot down and out.

   附近的肌腱同樣也起到維持踝關節(jié)的作用,。跟腱是人體在走、跑,、跳等活動時最重要的肌腱,。它連接小腿肌肉與跟骨，可以讓我們做腳趾站立的動作,。脛后肌腱附著在小腿肌肉群中較小的一塊并連著腳底,。該肌腱有助于支撐足弓，并且能夠讓我們做腳向內收的動作,。脛前肌腱可以讓我們做腳抬起來的動作,。腳踝的外側隆凸狀結構（外踝）后面有兩條肌腱走行。這兩個肌腱,，被稱為腓骨肌腱,，有助于我們做腳向下屈和向外翻的動作。

Muscles

肌肉

Most of the motion of the ankle is caused by the stronger muscles in the lower leg whose tendons pass by the ankle and connect in the foot. Contraction of the muscles in the leg is the main way that we move our ankle when we walk, run, and jump.

   小腿肌肉比較強壯,，它的肌腱經過踝關節(jié),，并且連接在足部，基于此,，踝關節(jié)的大多數(shù)動作都是由小腿肌肉引發(fā)的,。當我們走、跑,、跳的時候,，腿部肌肉收縮是引起踝關節(jié)活動的主要途徑。

The key ankle muscles have been discussed earlier in the section on ligaments and tendons. These muscles and their actions are also listed here.

   關鍵的踝部肌肉已經在前面的韌帶與肌腱部分論述過了,。這些肌肉及其作用也羅列如下,。

· The peroneals (peroneus longus and peroneus brevis) on the outside edge of the ankle and foot bend the ankle down and out.

· 腓骨肌肉群（腓骨長肌和腓骨短肌）位于踝和腳的外側,，能使踝關節(jié)跖屈和外翻,。

· The calf muscles (gastrocnemius and soleus) connect to the calcaneus by the Achilles tendon. When the calf muscles tighten, they bend the ankle down.

· 小腿肌肉群（腓腸肌和比目魚肌）通過跟腱連接到跟骨,。當小腿肌肉收縮,，可以使踝關節(jié)跖屈。

· The posterior tibialis muscle supports the arch and helps turn the foot inward.

· 脛后肌支撐足弓,，并能使腳做向內收的動作,。

· The anterior tibialis pulls the ankle upward.

· 脛前肌能使踝關節(jié)做背伸的動作,。

Nerves

神經

The nerve supply of the ankle is from nerves that pass by the ankle on their way into the foot. The tibial nerve runs behind the medial malleolus. Another nerve crosses in front of the ankle on its way to top of the foot. There is also a nerve that passes along the outer edge of the ankle.

  踝關節(jié)神經支配來自于行經踝關節(jié)到達足部的一些神經，這些神經分出分支進入踝關節(jié),。脛神經走行于內踝后方,。另一個神經走行于踝前方到達足背。還有一條神經沿著踝的外側緣通過,。

The nerves on the front and outer edge of the ankle control the muscles in this area, and they give sensation to the top and outside edge of the foot.

   分布于踝前面和外側緣的神經控制著這些區(qū)域的肌肉,，同時它們傳遞感覺到足背和足外側邊緣,。

Blood Vessels

血管

The ankle gets blood from nearby arteries that pass by the ankle on their way to the foot. The dorsalis pedis runs in front of the ankle to the top of the foot. (You can feel your pulse where this artery runs in the middle of the top of the foot.) Another large artery, called the posterior tibial artery, runs behind the medial malleolus. It sends smaller blood vessels to the inside edge of the ankle joint. Other less important arteries entering the foot from other directions also supply blood to the ankle.

   踝關節(jié)附近的動脈經過踝關節(jié)到達足的走行中分出分支進入踝關節(jié),。足背動脈走行于踝前方到足背。（你可以在足背中間感受到該動脈的搏動,。）另一個大動脈,，稱為脛后動脈，走行于內踝后方,。從它這里分出更小的血管進入踝關節(jié)的內側,。另外，進入足部的其他來源的并且相對次要的動脈也給踝關節(jié)供應血液,。

Summary

總結

As you can see, the anatomy of the ankle is very complex. When everything works together, the ankle functions correctly. When one part becomes damaged, it can affect every other part of the ankle and foot, leading to problems.

   正如你所看到的,，踝關節(jié)的解剖非常復雜。當所有的組成部分共同協(xié)作時,，踝關節(jié)才能正常地運作,。當一個部分受損時，它可能會影響踝關節(jié)和腳的其他部分,，從而導致問題的出現(xiàn),。

(韓健勇  譯         沈延東  校）

韓健勇，男,，主治醫(yī)師,，畢業(yè)于第二軍醫(yī)大學。

沈延東醫(yī)師簡介

寧波市醫(yī)療中心李惠利醫(yī)院骨科主任醫(yī)師

中國醫(yī)療保健國際交流促進會骨科分會足踝外科學組全國委員

中華醫(yī)學會骨科學分會足踝外科學組青年委員

寧波市醫(yī)學會骨科學分會足踝外科學組組長成員

寧波市醫(yī)學會醫(yī)學鑒定專家?guī)斐蓡T

寧波市康復醫(yī)學會骨科分會委員

      注重于復雜型關節(jié)內外骨折,、骨盆和復雜髖臼骨折的手術,，尤其是老年性骨折、人工關節(jié)置換,、復雜的足踝部骨折脫位,，足踝韌帶、肌腱及軟骨損傷,，踇趾外翻,、扁平足、馬蹄內翻足,、高弓足,、足踝先天性畸形的矯正,，足踝部關節(jié)炎、腫瘤以及足跟疼痛癥的治療等,。

專家門診時間：周二上午（骨科）    周三下午（足踝外科）

患者指南,，圖文并茂，

分門別類,，構思巧妙,。

深入淺出，中英對照,，

醫(yī)患攜手,，共同探討。

能力有限,，時間倉促,，

錯誤難免，誠惶誠恐,。

懇請各位,，留言指導，

以利再版,，更加周到,。