膝关节板股韧带的解剖学与临床研究

The anatomical and clinical research of the meniscofemoral ligaments

目的 调查板股韧带（meniscofemoral ligaments，MFLs）发生率，研究MFLs紧张-松弛模式，确定其股骨止点大小、形态及其与后十字韧带（posterior cruciate ligament，PCL）股骨止点位置关系，探讨MFLs功能及其在PCL双束重建股骨骨道定位中的作用。方法 解剖研究：30例成人膝关节标本，调查MFLs发生率，研究MFLs在屈伸膝过程中的紧张-松弛模式及其作用，测量其股骨止点面积，确定其股骨止点与PCL前外侧束（anterolateral bundle，ALB）及后内侧束（posteromedial bundle，PMB）股骨止点间位置关系。临床研究：89例单独PCL断裂膝关节与23例PCL断裂合并其他韧带损伤膝关节，关节镜下观察MFLs发生情况，确定MFLs股骨止点与ALB及PMB股骨止点间位置关系。结果 解剖研究：Humphry韧带紧张-松弛模式与ALB基本相同，出现率为3％（1／30），其股骨止点近似椭圆形，面积为（18．14±3．05）mm^2，位于ALB与PMB交界线的远侧；Wrisberg韧带紧张-松弛模式与PMB相似，出现率为90％（27／30），其股骨止点也近似椭圆形，平均面积为（25．63±7．92）mm^2，位于PMB股骨止点的近侧。临床研究：Humphu韧带出现率为1．7％（2／112），Wrisberg韧带出现率为59．8％（67／112），二者均低于解剖学研究结果（P〈0．05），PCL合并多发韧带损伤时前、后MFLs出现率分别为0％与13．0％（3／23），二者均低于单独PCL断裂中结果（P〈0．05），MFLs股骨止点与ALB及PMB股骨位置关系与解剖学研究结果相同。结论 MFLs发生率与创伤有关，MFLs对膝关节稳定具有一定作用，Wrisberg韧带在深屈膝时具有防止PCL前外束与髁间窝发生撞击的作用，MFLs股骨止点可分别作为ALB与PMB股骨骨道定位标志。PCL重建术及半月板切除术中应尽可能保留MFLs。

Objective To provide data on the incidence, shape, and sizes of the femoral attachments of meniscofemoral ligaments （MFLs）, and to determine the function of MFLs and the role in the femoral tunnel positioning in the double-bundle reconstruction of PCL. Methods Anatomical study： Thirty cadaveric knees were used to investigate the incidence and tightening-slackening patterns during the knee flexion-extension of MFLs. Data were obtained to describe the size, shape, and the relationship between the position of the femoral attachment of MFLs and that of anterolateral bundle（ALB） and the posteromedial bundle（PMB） were determined. Clinical study： During arthroscopic reconstruction of PCL, the presence of MFLs was confirmed in 112 patients by observation and probing, the relationship between the femoral attachment of MFLs and that of ALB and PMB were determined. Results Anatomical study： The Humphry ligament and Wrisberg ligament were presented in 1 （3%） and 27 （90%） case respectively. The femoral attachments were approximately ellipse both. The mean area was （18.14±3.05） mm^2 and （25.63±7.92） mm^2 respectively. Clinical study： The Humphry ligament and Wrisberg ligament were present in 2 cases （1.7%） and 67 cases （59.8%） respectively. The incidence of MFLs in knees with isolated PCL injury was highter than that in knees with muhiple ligaments injuries. Conclusion The incident of MFLs is related to the trauma of the knee, and the Wrisberg ligament plays an important role in avoiding impingement between the ALB and the intercondylar roof during deep knee flexion. The Humphry ligament and the Wrisberg ligament are landmarks for the tunnel positioning of ALB and PMB in double-bundle PCL reconstruction respectively.