셋째종아리근힘줄 닿는곳의 특징에 따른 형태학적 분류: 시신연구
Morphologic Analysis and Classification in Insertion of the Fibularis Tertius Tendon : A Cadaveric Study
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초록
셋째종아리근은 종아리뼈의 안쪽면에서 시작하여 다섯째발허리뼈의 몸쪽부분에 부착하는 근육이다. 본 연구의 목적은 한국인 시신을 대상으로 셋째종아리근의 닿는곳의 형태를 분류하고 위치를 계측하여 다섯째발허리뼈의 찢김골절의 발생 기전에 작용하는 셋째종아리근힘줄의 역할에 대한 해부학적 근거를 마련하고자 함이었다. 이를 위하여 포르말린으로 고정된 한국인 시신의 발 89쪽 (남자 61쪽, 여자 28쪽)의 발을 해부하였다. 셋째종아리근힘줄에서 닿는곳의 형태학적 분류는 Ercikti 등의 분류법을 사용하였고, 다섯째발허리뼈에 닿는 셋째종아리근의 너비를 측정하여 유형별로 분석하였다. 연구 결과, 셋째종아리근힘줄은 없는 경우를 제외하고 1유형 (한갈래) 56%, 2유형 (두갈래) 44%였다. 힘줄이 없는 경우가 7쪽이었으며 (7.9%), 1a유형은 2쪽 (2.2%), 1b유형은 26쪽 (29.2%), 1c유형은 16쪽(18.0%), 1d유형은 2쪽 (2.2%)이었으며, 2a유형은 35쪽 (39.3%), 2b유형은 1쪽 (1.1%)이었다. 다섯째발허리뼈에 닿는 셋째종아리근힘줄의 너비는 1a유형이 15.50±2.12 mm, 1b유형이 19.23±3.91 mm, 1c유형이 17.43±3.91 mm, 1d유형이 12.22±7.07 mm였고, 2a유형이 20.42±5.12 mm, 2b유형이 20.00 mm였다. 각 유형별로 통계적으로 유의한 차이는 없었다. 셋째종아리근힘줄의 너비는 성별과 좌우에 따른 차이가 없었다. 본 연구를 통해 셋째종아리근힘줄 닿는곳이 넓은 형태 (1b유형, 1c유형, 2a유형)가 총 86.5%가 되는 것을 확인할 수 있었다. 결론적으로, 셋째종아리근힘줄의 닿는곳 형태는 다섯째발허리뼈의 몸쪽부착부위에 부하가 가능할 것으로 예측되었으며, 이를 근거로 다섯째발허리뼈찢김골절과 관련하여 셋째종아리근힘줄의 닿는곳의 도식화 연구나 생체역학연구의 필요성을 제시하는 바이다.
Abstract
The fibularis tertius muscle originates on the medial surface of the fibula and attaches to the proximal portion of the fifth metatarsal bone. The aim of this study is to provide an anatomical basis for the role of the fibularis tertius tendon in the mechanism of fifth metatarsal avulsion fracture by classifying the shape and location of the fibularis tertius tendon in Korean cadavers. For this study, 89 feet were dissected using formalin-fixed Korean cadavers. There were 61 male and 28 female, and the average at death age was 78.79±11.00 years. Ercikti’s method was applied for classification according to the shape of the insertion in the fibularis tertius tendon, and the width of the footprint of insertion was measured additionally. As a result, the fibularis tertius tendon was type 1 (one-branch) in 56% and type 2 (two-branch) in 44%. Tendons were absent in 7 feet (7.9%), type 1a in 2 feet (2.2%), type 1b in 26 feet (29.2%), type 1c had 16 feet (18.0%), type 1d had 2 feet (2.2%), type 2a had 35 feet (39.3%), and type 2b) was 1 feet (1.1%). The width of the fibularis tertius tendon attachment site was 15.50±2.12 mm in types 1a, 19.23±3.91 mm in types 1b, 17.43±3.91 mm in types 1c, 12.22±7.07 mm in types 1d, 20.42±5.12 mm in type 2a, 20.00 mm in type 2b. There was no difference in the width of the fibularis tertius tendon according to gender and side. In conclusion, the shape of the fibularis tertius tendon contact point would be able to load the proximal attachment part of the fifth metatarsal bone. Based on this, we suggest the need for a schematic study or biomechanical study of the fibularis tertius tendon in relation to the fifth metatarsal avulsion fracture.
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