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OBJECTIVE: To develop and test an experimental model for in vivo short-term recording of peak isometric forces of the digital flexor muscles in the forelimb of adult horses. STUDY DESIGN: In vivo experimental study. SAMPLE POPULATION: Four healthy, anesthetized, adult Thoroughbred horses (3 to 7 years old; 527 +/- 87 kg) METHODS: In dorsal recumbency, ulnar and median nerves were exposed and instrumented with insulated bipolar cuff stimulation electrodes for later connection to an electrical stimulator. In left lateral recumbency, a biplanar fixator was applied to the right humerus and a custom-made, rigid, aluminum frame connected to it, to allow loading of muscles distal to the fixator. Threaded transfixation pins through the radial and metacarpal condyles were clamped to the rigid frame so that the humerus, radius, ulna, and metacarpus were fixed in position. Each digital flexor muscle insertion tendon was transected just above the metacarpophalangeal joint, extracted from the carpal canal, and secured in a metal clamp positioned at the distal myotendinous (MT) junction. Distally, the clamp was connected in series to a load cell and a pneumatic actuator to record force and to maintain muscle length during nerve stimulation. A linear potentiometer was connected in parallel to the actuator to record MT junction position. Initial trials were conducted to identify median and ulnar nerve stimulation variables to achieve maximal muscle contraction. Isometric contractions were performed at different muscle lengths and peak forces registered during 3 seconds of supramaximal dual (ulnar and median) nerve stimulation. RESULTS: A stimulation voltage of 2.5 to 5.0 V at 50 Hz usually produced maximal force for both the superficial digital flexor (SDF) and deep digital flexor (DDF) muscles. Single ulnar and median nerve stimulation elicited force development not only in the DDF muscle but also in the SDF muscle. At voltages higher than 1 V, normalized force was greatest with combined median and ulnar nerve stimulation for both the DDF and SDF muscles; however, normalized force was greater for median nerve stimulation than ulnar nerve stimulation in the DDF muscle, and the opposite relationship was observed for the SDF muscle. Final recording of dual supramaximal nerve stimulation of SDF and DDF muscles resulted in peak isometric forces of 716 +/- 192 N and 1,577 +/- 203 N, respectively. CONCLUSIONS: The instrumentation technique and experimental protocol enabled recording of peak isometric forces in the SDF and DDF muscles of anesthetized adult horses. CLINICAL RELEVANCE: Studies using this model will improve knowledge of SDF and DDF muscle mechanics with insight to functional implications of the complex architecture of these muscles. Knowledge of the dynamic performance of the SDF and DDF muscles would also be useful for the development of new treatment strategies for flexor deformities and tendon injuries in horses.  相似文献   

3.
OBJECTIVE: To calculate forces in the flexor tendons and the influence of heel wedges in affected and contralateral (compensating) forelimbs of horses with experimentally induced unilateral tendinitis of the superficial digital flexor (SDF) tendon. ANIMALS: 5 Warmblood horses. Procedure-Ground reaction force and kinematic data were obtained during a previous study while horses were trotting before and after induction of tendinitis in 1 forelimb SDF and after application of 6 degrees heel wedges to both forehooves. Forces in the SDF, deep digital flexor (DDF), and the suspensory ligament (SL) and strain in the accessory ligament (AL) of the DDF were calculated, using an in vitro model of the distal region of the forelimb. RESULTS: After induction of tendinitis, trotting speed slowed, and forces decreased in most tendons. In the affected limb, SL force decreased more than SDF and DDF forces. In the compensating limb, SDF force increased, and the other forces decreased. After application of heel wedges, SDF force in both limbs increased but not significantly. Furthermore, there was a decrease in DDF force and AL strain. CONCLUSIONS AND CLINICAL RELEVANCE: The increase in SDF force in the compensating forelimb of horses with unilateral SDF tendinitis may explain the high secondary injury rate in this tendon. The lack of decrease of SDF force in either limb after application of heel wedges suggests that heel wedges are not beneficial in horses with SDF tendinitis. Instead, heel wedges may exacerbate the existing lesion.  相似文献   

4.
Effects of longitudinal compression before and after transection of the accessory ligament of the superficial digital flexor (SDF) muscle were measured in eight equine cadaver forelimbs. When compression was increased from 890 N to 3115 N, the metacarpophalangeal (MCP) and carpal joints hyperextended 20 degrees and 4 degrees, respectively, and strain in the SDF and deep digital flexor tendons was increased 3.5% and 1.4%, respectively. The accessory ligament did not elongate. Immediately after transection of the accessory ligament at 3115 N load, a 2.8 mm gap formed between the transected ends of the accessory ligament, and the muscle belly of the SDF elongated and moved distad. The MCP joint hyperextended 15.8% further and strain of the SDF tendon increased 11.2% further. These results show that the accessory ligament transferred load in the SDF musculotendinous unit away from the muscle belly and that desmotomy altered this function. Decrease in the MCP joint angle indicated that the accessory ligament contributed to the support of the MCP joint under load. Increase in SDF strain after desmotomy was probably influenced by the change in the moment about the MCP joint and increased length of the SDF musculotendinous unit.  相似文献   

5.
OBJECTIVE: To measure the effects of transection of the accessory ligament of the superficial digital flexor (SDF) muscle (superior check desmotomy) on flexor tendon and suspensory ligament (SL) strain in vitro. STUDY DESIGN: In vitro experimental biomechanical investigation. ANIMALS USED: Ten equine cadaver forelimbs. METHODS: The effects of superior check desmotomy were determined using equine cadaver forelimbs secured in a servocontrolled hydraulic testing machine. Strain sensors were used to measure strain on the superficial and deep digital flexor tendons and SL, and a goniometer was used to measure joint angles when the limb was loaded at 890 N and 3,115 N before desmotomy, and at 3,115 N after desmotomy. RESULTS: Superior check desmotomy was associated with significantly increased strains on the SDF tendon and SL, and significant alterations in the angles of the metacarpophalangeal and carpal joints. CONCLUSIONS: The superior check ligament has an important role in maintaining joint angles and load distribution in the forelimb. Lengthening of the SDF musculotendinous unit after superior check desmotomy may be associated with increased strain on the SL. CLINICAL RELEVANCE: Transection of the accessory ligament of the SDF muscle may predispose horses to SL desmitis postoperatively.  相似文献   

6.
OBJECTIVE: To describe a method to calculate flexor tendon forces on the basis of inverse dynamic analysis and an in vitro model of the equine forelimb and to quantify parameters for the model. SAMPLE POPULATION: 38 forelimbs of 23 horses that each had an estimated body mass of > or = 500 kg. PROCEDURE: Longitudinal limb sections were used to determine the lines of action of the tendons. Additionally, limb and tendon loading experiments were performed to determine mechanical properties of the flexor tendons. RESULTS: The study quantified the parameters for a pulley model to describe the lines of action. Furthermore, relationships between force and strain of the flexor tendons and between fetlock joint angle and suspensory ligament strain were determined, and the ultimate strength of the tendons was measured. CONCLUSION AND CLINICAL RELEVANCE: The model enables noninvasive determination of forces in the suspensory ligament, superficial digital flexor tendon, and distal part of the deep digital flexor (DDF) tendon. In addition, it provides a noninvasive measure of loading of the accessory ligament of the DDF tendon for within-subject comparisons. However, before application, the method should be validated. The model could become an important tool for use in research of the cause, prevention, and treatment of tendon injuries in horses.  相似文献   

7.
Objective —To describe the tenoscopic anatomy of the carpal sheath of the flexor tendons (carpal sheath) viewed from a lateral approach.
Study Design —Tenoscopic observation of structures within the carpal sheath subsequently confirmed by dissection.
Animals or Sample Population—12 equine cadaveric forelimbs.
Methods —The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal for the arthroscope was made approximately 3 cm proximal to the distal radial physis and 2.5 cm caudal to the radius between the tendons of the ulnaris lateralis and lateral digital extensor muscles.
Results —A lateral tenoscopic approach was adequate to identify all structures within the carpal sheath. From proximal to distal, structures identified using this approach were the radial head of the deep digital flexor muscle, accessory ligament of the tendon of the superficial digital flexor muscle, distal radial physis, tendons of the superficial and deep digital flexor muscles, accessory carpal bone, antebrachiocarpal and middle carpal joints, and vincula of the tendon of the deep digital flexor muscle.
Conclusions —A lateral tenoscopic approach offered an easy, repeatable entry into the carpal sheath and allowed good observation of all structures within the sheath except for the medial borders of the tendons of the deep and superficial digital flexor muscles.
Clinical Relevance —Applications of a lateral tenoscopic approach to the carpal sheath include diagnostic procedures, lavage and synovial resection for septic tenosynovitis, desmotomy of the accessory ligament of the tendon of the superficial digital flexor muscle for flexural deformity or tendinitis, and removal of osteochondromas from the distal radial metaphysis.  相似文献   

8.
Soft tissue injuries of the shoulder are an important cause of forelimb lameness in dogs. The objectives of this canine cadaver study were to describe normal anatomy of shoulder soft tissue structures using computed tomography (CT) and computed tomographic arthrography (CTA) and to determine the effects of positioning on visualization of shoulder soft tissue structures. Thirteen forelimbs were removed from eight canine cadavers. Two forelimbs were used for contrast dose optimization. For the remaining 11 forelimbs, shoulder CT and CTA were performed using three defined joint angles (140°, 90°, and 70°). For three forelimbs, CT and CTA images were compared with frozen anatomic sections to describe normal anatomy. Ten forelimbs were used for analysis of positioning effects. Soft tissue structures evaluated were the joint capsule, cartilage, ligaments, tendons, and muscles. A visual assessment score was assigned to each structure using a consensus of two observers. The range and mode of scores were calculated and compared for each modality and limb position. The shoulder joint capsule and medial and lateral glenohumeral ligaments were completely visible with CTA. All tendons and muscles were visualized in all the examinations except for the teres minor muscle tendon and the coracobrachialis muscle, which were not visible on all scans. Positioning the limb in an extended position significantly improved visualization of most soft tissue shoulder structures. Shoulder cartilage was best seen with CTA and with neutral or flexed positioning of the shoulder. Findings indicated that both CT and CTA are feasible imaging techniques for visualization of soft tissue structures of the canine shoulder.  相似文献   

9.
Experimental tenectomies were performed in the mid metacarpal region of the superficial digital flexor (SDF) tendon while the deep digital flexor (DDF) tendon was traumatized in 10 donkeys. In group I (n=8) the deep frozen tendons were used for grafting where as in group II (n=2) no grafting was done. Amniotic membrane casing was performed around grafted SDF and traumatized DDF tendons in group I only. Gross and histomorphological observations were recorded on the last day of the experiment, i.e., on the 15th (n=1), 30th (n=2), 60th (n=2), 90th (n=2) and 120th (n=1), post-operative days (POD) in group I and on the 60th (n=1) and 120th (n=1) POD in group II. Gross intraoperative observations suggested the presence of only thin filamentous adhesions in all but three animals at 30 (two animals) and 60 (one animal) days which were present only in the limited area of grafted tendon as compared to tenectomized SDF tendon that showed thick fibrous adhesion and thickening at both the cut ends. However, DDF tendon showed no adhesions in all except one animal of group I as compared to group II where adhesions were noticed in both the animals. Histological examination suggested an increase in fibroblastic activity at 2 weeks after grafting. Extrinsic and intrinsic healing response was observed in grafted tendons. Inflammatory reaction was reabsorbed by one month. The bundle formation was observed from two to three months. The histological structure appeared near normal by 4 months. Observation suggested that homologous tendon grafts remain viable by all histological criteria and healing was at a comparatively more advanced stage than tenectomized tendon. However, the traumatized DDF tendon healed completely by two months. It is concluded that the tendon healing was more rapid in animals where deep frozen grafts had been used.  相似文献   

10.
OBJECTIVE: To test the failure strength and energy of 2 bioabsorbable implants applied to transected deep digital flexor tendons (DDFT) from adult horses. STUDY DESIGN: Ex vivo biomechanical experiment. SAMPLE POPULATION: Twelve pairs of deep digital flexor tendons harvested from the forelimbs of fresh equine cadavers. METHODS: Poly-L-lactic acid tendon plates were custom manufactured for application to the cylindrical surface of an adult equine deep digital flexor tendon. Twelve pairs of DDFTs were transected 2 cm distal to the insertion of the distal check ligament of the deep digital flexor tendon. One tendon of each pair was randomly selected for repair with a biodegradable plate or a 3-loop pulley method. Size 2 polydioxanone suture was used in both repairs. Repairs were tested in tension to failure, with peak force (PF) and total energy (TE) at repair failure recorded in Newtons (N) and Joules (J), respectively. A paired t-test was used for statistical evaluation with a significant level set at P< or = .05. RESULTS: Mean+/-SD PF for failure of plated tendons (1507.08+/-184.34 N) was significantly greater than for sutured tendons (460.86+/-60.93 N). TE was also significantly greater for failure of plated tendons versus sutured tendons. CONCLUSIONS: Plate fixation of transected cadaver DDFTs appear to have superior immediate failure strength than 3-loop pulley repairs. CLINICAL RELEVANCE: Whereas in vivo testing is required, a bioabsorbable tendon plate may provide initial increased strength to support tendon healing and decrease external coaptation requirements.  相似文献   

11.
OBJECTIVE: To determine the detailed computed tomography (CT) anatomy of the metacarpophalangeal (MCP) joint in healthy horses. SAMPLE POPULATION: 10 cadaveric forelimbs from 10 adult horses without orthopedic disease. PROCEDURES: CT of the MCP joint was performed on 4 forelimbs. In 1 of the limbs, CT was also performed after intra-articular injection of 30 mL of contrast medium (40 mg of iodine/mL). Transverse slices 1-mm thick were obtained, and sagittal and dorsal planes were reformatted with a slice thickness of 2 mm. The CT images were matched with corresponding anatomic slices from 6 additional forelimbs. RESULTS: The third metacarpal bone, proximal sesamoid bones, and proximal phalanx could be clearly visualized. Common digital extensor tendon; accessory digital extensor tendon; lateral digital extensor tendon; superficial digital flexor tendon (including manica flexoria); deep digital flexor tendon; branches of the suspensory ligament (including its attachment); extensor branches of the suspensory ligament; collateral ligaments; straight, oblique, and cruciate distal sesamoidean ligaments; intersesamoidean ligament; annular ligament; and joint capsule could be seen. Collateral sesamoidean ligaments and short distal sesamoidean ligaments could be localized but not at all times clearly identified, whereas the metacarpointersesamoidean ligament could not be identified. The cartilage of the MCP joint could be assessed on the postcontrast sequence. CONCLUSIONS AND CLINICAL RELEVANCE: CT of the equine MCP joint can be of great value when results of radiography and ultrasonography are inconclusive. Images obtained in this study may serve as reference for CT of the equine MCP joint.  相似文献   

12.
Objective— To describe a tenoscopic approach to the carpal sheath for desmotomy of the accessory ligament of the superficial digital flexor tendon. Study Design— The surgical procedure was developed with use of normal forelimbs from equine cadavers and experimental horses. Animals or Sample Population— Twelve equine cadaveric forelimbs, 4 forelimbs from 2 horses anesthetized for terminal surgical laboratories, and 10 forelimbs from five experimental horses were used. Methods— The limbs were positioned lateral side up with the carpus slightly flexed. After distention of the carpal sheath, a portal was made approximately 2 cm proximal to the distal radial physis for arthroscope insertion. An instrument portal was made approximately 0.2 cm proximal to the distal radial physis. After flexion of the limb to 90°, the accessory ligament of the superficial digital flexor tendon was palpated and desmotomy was performed. Cadaveric limbs were dissected to confirm complete desmotomy. Experimental horses were monitored for short- (perioperative) and long- (4 weeks) term postoperative complications. Results— A tenoscopic approach to the carpal sheath provided adequate surgical access to the accessory ligament of the superficial digital flexor tendon for desmotomy. Most of the accessory ligament of the superficial digital flexor tendon could be easily seen within the sheath, except for the proximal 2 cm that could be readily palpated and subsequently transected. Important technical considerations were location of the arthroscope portal, adequate sheath distention, limb flexion to 90°, and desmotomy location. It was beneficial, but apparently not essential, to avoid the proximal perforating vessel. Postoperatively, some horses had swelling but were not lame and had normal range of motion of the carpus. Conclusions— Desmotomy of the accessory ligament of the superficial digital flexor tendon could be performed by using a lateral tenoscopic approach to the carpal sheath. Clinical Relevance— Desmotomy of the accessory ligament of the superficial digital flexor tendon by using a tenoscopic approach to the carpal sheath is an alternative technique to the medial incisional approach.  相似文献   

13.
OBJECTIVE: To demonstrate myofibroblasts in the accessory ligament of the deep digital flexor tendon (ie, distal check ligament) and deep digital flexor tendon of clinically normal foals. SAMPLE POPULATION: Tissue specimens from 25 foals that were necropsied for reasons unrelated to this study and unrelated to musculoskeletal disease. PROCEDURE: The distal check ligament and deep digital flexor tendon of both forelimbs were examined histologically. Myofibroblasts were identified by immunohistochemical staining specific for alpha-smooth muscle actin (alpha-SMA). RESULTS: Most of the cells in the distal check ligament and deep digital flexor tendon of all foals stained positive for alpha-SMA. CONCLUSION AND CLINICAL RELEVANCE: Myofibroblasts made up most of the cells in the distal check ligament and deep digital flexor tendon of clinically normal foals. These cells have contractile ability and therefore, may play a role in flexure contracture of these tendons. The ability of tetracycline to chelate calcium or decrease the expression of the contractile protein alpha-smooth muscle actin could inhibit the myofibroblasts' ability to contract, thus providing a rationale for tetracycline administration as a treatment of distal interphalangeal joint flexor deformity in foals.  相似文献   

14.
Several techniques have been described for canine pancarpal arthrodesis (PCA) with dorsal plating becoming the most accepted method for ease of placement despite the proposed biomechanical disadvantages. The aim of this study was to compare the biomechanical effects of the addition of crossed K-wires to a standard 2.7/3.5 mm hybrid PCA plate. A 2.7/3.5 mm hybrid PCA plate, alone and combined with crossed K-wires were tested. Six pairs of cadaver forelimbs were collected from medium-sized dogs with an average weight of 24 kg by elbow disarticulation. The limbs were potted and fixed in an Instron load cell (Instron, High Wycombe, UK) and axially loaded to failure. Load displacement data and mode of failure were recorded and stiffness, yield load and ultimate load at failure were calculated. The yield load (kN) of the plate and K-wire construct (1.278+/-0.11) was significantly higher than for the plate construct alone (1.002+/-0.07) (p=0.00056). However, the differences between the two constructs in stiffness and failure loads were not significant.  相似文献   

15.
In 21 animals, chronic swelling on the lateral aspect of the stifle also known as ?perigonitis?, ?stable-syndrome? or ?bursitis bicipitalis femoris? were evaluated. Ultrasonography showed increased fluid in the distal subtendinous bursa of the biceps femoris muscle and structural changes in the tendons, muscles, subcutis and fasciae. Soft tissue swelling and an irregular contour of the lateral tibial condyle were typical signs on radiographs. Macroscopic changes were found at the insertion of the biceps femoris muscle, the distal subtendinous bursa of the biceps femoris muscle, the lateral collateral ligament of the stifle, the origin of muscles on the lateral femoral condyle and the lateral tibial condyle. They mainly consisted of tendon and muscle tissue necrosis with granulation tissue. Histology revealed areas of coagulation necrosis in tendons and ligaments, in which occasionally Onchocerca spp. were seen. The severity of lesions correlated well with the clinical signs, which were associated with a poor prognosis in advanced cases.  相似文献   

16.
The usefulness of inferior check ligament desmotomy as a treatment for acquired tendon contracture in horses was evaluated in 13 cases of deep digital flexor (DDF) contracture and in 3 cases of combined superficial digital flexor (SDF) and DDF contracture. In 8 of 9 cases of DDF contracture in which the dorsal surface of the hoof had not passed beyond being vertical to the ground, the surgical procedure was successful in returning the limb to a normal position and function. Compared with DDF tenotomy, inferior check ligament desmotomy was a superior treatment technique because of decreased postoperative pain, better postoperative appearance, and improved return to function. In 4 cases of DDF contracture in which the dorsal SDF contracture was also involved, inferior check ligament desmotomy was generally insufficient to allow return of the limb to normal alignment and function.  相似文献   

17.
Effective treatments for horses diagnosed with severe deep digital flexor (DDF) tendinopathy are limited. In this study, three Quarter Horses diagnosed with severe bilateral DDF tendinopathy underwent bilateral desmotomy of the accessory ligament of the DDF tendon after failing to respond to conservative therapy. Lameness markedly improved in all three horses. Given that severe DDF tendinopathy is typically associated with persistent or recurrent lameness, desmotomy of the accessory ligament of the DDF tendon might be a treatment option to alleviate lameness in horses with DDF tendinopathy. This treatment option appears promising; however, a larger number of cases is necessary to support the results in these three horses.  相似文献   

18.
AIM: To determine the effect of polyester (terylene) fibre implants on normal equine superficial digital flexor (SDF) tendon structure. METHODS: Normal forelimb SDF tendons (n=24) of 12 horses were divided into unoperated, sham-operated, and implanted (terylene fibre implant) groups. Horses were assessed for lameness and ultrasonographic changes to SDF tendons at intervals up to 48 weeks post-operatively. After euthanasia, SDF tendons were collected for histological and ultrastructural examination. Histological sections were examined for alcian blue staining intensity, cellularity, fibril bundle alignment, fascicle separation and crimp morphology. Mass-average diameters (MADs) of collagen fibrils were calculated from electron micrographs and compared between treatment groups. RESULTS: Insertion of terylene fibre implants resulted in short-term (8 weeks) lameness in implanted limbs. Ultrasonographically, the implants could be detected in 50% of implanted tendons, but were associated with tendon swelling and the presence of hypoechoic core lesions in 7/8 implanted limbs. There were significant alterations in alcian blue staining, cellularity and crimp morphology in the central fascicles of sham-operated and implanted tendons, and alteration in fibril alignment in the central fascicles of implanted tendons. Unoperated tendons remained histologically normal. MADs of collagen fibrils did not differ between sham-operated, implanted and unoperated limbs. CONCLUSIONS: Both the sham procedure and the insertion of terylene fibre implants led to alterations in tendon structure that persisted for up to 48 weeks. Persistence of disorganised connective tissue at the proximal and distal ends of the terylene fibre implants may predispose implanted tendons to continued risk of injury. CLINICAL RELEVANCE: It is unlikely that terylene fibre implants offer any advantage over standard non-surgical treatments for mild to moderate cases of SDF tendonitis in the horse.  相似文献   

19.
Tendon injuries are an important problem in athletic horses and are probably caused by excessive loading of the tendons during demanding activities. As a first step towards understanding these injuries, the tendon loading was quantified during jump landings. Kinematics and ground reaction forces were collected from the leading and trailing forelimbs of 6 experienced jumping horses. Joint moments were calculated using inverse dynamic analysis. It was found that the variation of movement and loading patterns was small, both within and between horses. The peak flexor joint moments in the coffin and fetlock joints were larger in the trailing limb (-0.62 and -2.44 Nm/kg bwt, respectively) than in the leading limb (-0.44 and -1.93 Nm/kg bwt, respectively) and exceeded literature values for trot by 82 and 45%. Additionally, there was an extensor coffin joint moment in the first half of the stance phase of the leading limb (peak value 0.26+/-0.18 Nm/kg bwt). From these results, it was concluded that the loading of the flexor tendons during landing was higher in the trailing than in the leading limb and that there was an unexpected loading of the extensor tendon in the leading limb.  相似文献   

20.
Despite the great progress in the field of tendon injuries and chronic tendinopathies in recent years, treatment of these conditions is still challenging. Research utilising animal models is crucial for further advancement in tendon research, with the rabbit being a commonly used species in this field. The objective of the present study was to comprehensively describe the macro‐ and microanatomy of the common calcanean tendon (tendo Achillei), together with associated structures. Eight female New Zealand rabbits were subjected to anatomical dissection and histologic analysis, revealing significant species‐specific features. The soleus muscle presented a thin, spindle shape with no tendon of insertion and attached directly to the lateral gastrocnemius muscle. Therefore, it does not contribute to the formation of the common calcanean tendon. The calcaneal tendon of the semitendinosus muscle was identified as a strong tendinous band at the medial side of the medial gastrocnemius muscle and the superficial digital flexor muscle and tendon distally. The saphenous artery was accompanied by the medial saphenous vein and characteristic accessory medial saphenous vein. The complex structure of the paratendinous connective tissue is described, with the paratenon being contiguous with the epitenon of the individual tendons and epimysium of associated muscles. At the level of the calcaneal tuber, the retromalleolar fat pad was identified, adhering to the cranial surface of the conjoint gastrocnemius tendon. Histologic studies confirmed the presence of the subtendinous calcaneal bursa of superficial digital flexor tendon and the bursa of calcaneal tendon.  相似文献   

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