人膝后外侧复合结构的解剖研究

发布时间：2018-06-23 17:51

本文选题：膝关节 + 外侧副韧带　；参考：《河北医科大学》2009年硕士论文

【摘要】： 目的:对人膝后外侧复合结构( posterior lateral complex;PLC)的解剖进行观察研究,为临床诊治提供解剖学基础。方法:选择8例人膝关节标本,排除膝关节损伤、肿瘤等疾患,解剖膝关节后外侧,辨认后外侧各结构起止点及走行,明确它们之间的解剖关系。对标本外侧副韧带(LCL)、乆肌腱复合体、乆腓韧带走行进行测量,计算各肌腱及韧带在不同平面上与腓骨长轴所形成的夹角,并对PLC各主要结构的抗旋转作用做生物力学测定。结果:膝关节后外侧包括三层结构,浅层包括髂胫束和股二头肌腱;中间层包括髌骨外侧支持带、髌股韧带、腓肠肌外侧头;深层由沿外侧半月板边缘附着的外侧关节囊、LCL、乆肌腱复合体、乆腓韧带、豆腓韧带、弓状韧带、后交叉韧带(PCL)、板股韧带等组成。髂胫束起于髂前上嵴,止于胫骨外侧平台Gerdy结节。髂胫束可分为浅层、深层和被膜骨性层。分离浅层后可见深层纤维紧密粘附于股骨外上髁并续于骨外侧肌间隔。其被膜骨性层起于外侧肌间隔和腓肠肌、跖肌后外侧筋膜,与股二头肌短头腱膜相延续。股二头肌腱下行至髂胫束后方,有长、短两个头,每个头又分为前支和直支。长头和短头直支与LCL以联合腱共同止于腓骨头外侧基底部;短头前支与外侧关节囊中三分之一共同止于胫骨上外侧面。腓总神经在股二头肌肌腱的后方深层,位于腓骨茎突远端1.5～2.0cm处。腓肠肌外侧头起于LCL起点后方,沿乆肌腱后方向远侧走行。腓肠豆是腓肠肌腱外侧头内的一个不确定存在的籽骨,腓肠豆腓骨韧带也不确定存在。本组8膝中发现有3膝存在腓肠豆。髌外侧支持带,起于髌骨外侧缘,止于胫骨近端外侧面。髌股韧带位于髌骨外侧支持带近端,起于髌骨外侧缘,止于股骨外侧髁。 LCL起于外侧股骨髁的外侧粗隆,起点位于腓肠肌腱外侧头股骨附着点的前方,并向远侧延伸斜越过腓肠肌腱,在髂胫束后方下行,与股二头肌腱以联合肌腱的方式联合止于腓骨头外侧方。乆肌起于胫骨近端后内侧,逐渐延伸并于外侧形成一根肌腱继续通过乆肌裂孔进入膝关节,在外侧股骨髁乆沟内移行,从LCL下方穿过,止于股骨外侧髁粗隆,形成乆肌腱复合体。沿途发出分支至外侧半月板后角和腓骨茎突,分别形成乆半月板韧带和乆腓韧带。乆腓韧带起于乆肌与腱连接处附近向远端和外侧走行,附着于腓骨茎突的内侧面,这条韧带短,腱强韧甚至比乆肌腱还要宽大。弓状韧带是一条呈“Y”形结构的关节囊增厚部分,分为内、外侧支,两支插入腓骨茎突顶端,正好位于豆腓韧带前方。内侧支弯曲越过乆肌和腱,与乆斜韧带汇合;外侧支沿关节囊上升,与外侧腓肠肌股骨髁止点附近关节囊融合。 PCL起于股骨内侧髁外侧面,向下后外方向走行,止于胫骨髁间棘后部。PCL表面覆盖有一层滑膜组织,滑膜鞘内有血管走行。在PCL与前交叉韧带(ACL)相交叉处,有类似于脂肪的组织将两根韧带相连,较为疏松。根据韧带纤维的起止部位,大体标本上PCL可分为前外束和后内束。板股韧带一般有一或两根,起于股骨内髁,止于外侧半月板后角。位于PCL前方的称Humphrey韧带,位于PCL后方的称Wrisberg韧带。各主要肌腱及韧带在不同平面上与腓骨长轴所形成的夹角:矢状面LCL为10°左右;冠状面乆腓韧带约29°左右;矢状面乆肌腱关节囊内部分51°左右;关节囊外部分44°左右。生物力学试验表明,膝关节后外侧的旋转稳定性由PLC的不同结构共同维持,在不同的屈膝角度,主要由不同的PLC结构提供。结论:人膝PLC结构复杂,大体分为三层结构。广义上的PLC结构包括组成膝关节后外侧的所有肌腱、韧带等结构,狭义上指后外侧角,即LCL、乆肌腱复合体、乆腓韧带和后外侧关节囊。通常将股二头肌腱、LCL、乆肌腱复合体、乆腓韧带看作是膝关节后外侧的主要结构,解剖中发现膝关节后外侧各结构间关系密切,相互之间连接成为一个整体,对膝关节后外侧发挥稳定、保护的作用,其中LCL、乆肌腱复合体和乆腓韧带结构最重要,这三个结构在膝关节后外侧形成一个稳固的三角形,有防止膝关节内翻、胫骨外旋和胫骨后坠的作用。生物力学试验表明,膝关节后外侧旋转稳定性主要由LCL、乆肌腱复合体提供,而PCL则是重要的辅助抗外旋结构。在不同的屈膝角度,膝关节后外侧的旋转稳定性分别由不同的PLC结构提供。熟悉PLC的解剖特点有助于利用X线片、CT或MRI表现对PLC的损伤作出正确诊断,也为临床上采取的修复或重建手术提供解剖学依据。
[Abstract]:Objective : To observe the anatomy of posterior lateral complex ( PLC ) and provide anatomical basis for clinical diagnosis and treatment .

Methods : Eight specimens of knee joint were selected to remove knee joint injury , tumor and other diseases . The anatomical relationship between them was determined . The included angle between each tendon and ligament and the long axis of fibula was calculated .

Results : The outer side of the knee joint comprises three layers of structure , the superficial layer includes the external iliac tibial band and the femoral head tendon ; the middle layer comprises the outer supporting belt of the patella , the patella ligament and the lateral head of the fibula muscle ; the deep layer consists of an outer joint capsule which is attached to the edge of the lateral meniscus ;

Iliotibial tract begins on the anterior superior iliac crest and terminates at the Gerdy nodules on the lateral tibial plateau . The iliac tibial band can be divided into superficial , deep , and membranous bony layers . The superficial layers of the superficial layer are closely adhered to the medial femoral condyle after separation of the superficial layer .

One third of the long head and the short head straight branch are common to the lateral basal part of the fibula head , and one third of the short anterior branch and the outer joint capsule are common to the outer lateral surface of the tibia .

It was found that there were 3 knees in the knee .

The Patellofemoral ligament is located on the outer side of the patella and terminates at the outer lateral surface of the proximal tibia . The patellar ligament is located on the outer side of the patella supporting the proximal end of the patella and acts on the lateral margin of the patella and terminates at the lateral condyle of the femur .

The lateral femoral condyle was located on the lateral side of the lateral femoral condyle . The origin was located in the anterior part of the femoral attachment point on the lateral head of the distal femur and extended obliquely across the tendon of the fibula to the distal side .

The medial side of the proximal tibia of the tibia , gradually extending and forming a tendon on the outer side , continues to enter the knee joint through the muscular rupture of the femur , and passes through the lateral femoral condyle groove , passes through the lateral condyle of the femur , and forms a tendon complex . The posterior horn of the lateral meniscus and the styloid process of the fibula are transmitted along the way to form the meniscus ligament and the transpepal ligament respectively .

The collateral ligament is a thickened part of the joint capsule of " Y " - shaped structure , which is divided into inner and outer branches , and the two branches are inserted into the top of the pedicle of the fibula . The medial branch bends over the muscle and the tendon and joins with the oblique ligament . The lateral branch rises along the joint capsule , and is fused with the joint capsule near the condyle stop point of the lateral fibula muscle .

The PCL is located on the lateral surface of the medial condyle of the femur , and runs in the posterior direction . The PCL surface is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . At the intersection of the PCL and the anterior cruciate ligament ( ACL ) , there is a tissue similar to the fat that connects the two ligaments , and is loose . According to the starting position of the ligament fiber , the PCL in the general specimen can be divided into a front outer beam and a rear inner beam .

The plate femoral ligament typically has one or two , starting from the medial femoral condyle , ending at the posterior horn of the lateral meniscus . The anterior tibial ligament is located in the anterior portion of the PCL and is located posterior to the PCL as the Wrisberg ligament .

The included angle of each major tendon and ligament with the long axis of fibula is about 10 掳 in sagittal plane , about 29 掳 in coronal plane , 51 掳 in sagittal plane , and 44 掳 out of joint capsule .

Biomechanical tests show that the rotational stability of the posterior lateral knee of the knee joint is maintained by the different structures of the PLC , and is mainly provided by different PLC structures at different knee angles .

Conclusion : The human knee PLC has a complex structure and is generally divided into three layers . The generalized PLC structure consists of all tendons , ligaments and other structures which form the outside of the knee joint .
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R687.3;R322

【引证文献】