膝关节半月板和冠状韧带的解剖学研究及其临床意义

Anatomy of the Meniscus and Coronary Ligaments of Knee Joint and Its Clinical Significance

目的：解剖观察膝关节冠状韧带的结构特点,为解除半月板滑动障碍松解膝冠状韧带提供解剖学基础.方法：解剖观察成尸膝关节标本32侧,观测胫骨髁与半月板及膝冠状韧带的形态、长宽和厚度.结果：（1）外侧半月板向前滑动（5.6±1.3）mm,向后滑动（8.7±1.7）mm;内侧半月板向前滑动（5.5±1.4）mm,向后滑动（7.4±1.8）mm.（2）外侧膝冠状韧带周长（87.2±9.6）mm,上下宽（15.4±3.0）mm,韧带厚（0.9±0.3）mm.（3）内侧膝冠状韧带周长（91.9±7.9）mm,上下宽（15.9±3.2）mm,韧带厚（0.8±0.2）mm.（4）外侧膝冠状韧带前外侧微创进刀点,在膝关节外侧中点向前（26.4±3.7）mm范围内,膝关节前正中点向外（20.2±5.8）mm范围内不宜进刀,两者之间为前外侧进刀点.（5）内侧膝冠状韧带前内侧微创进刀点,在膝关节内侧中点处宽（7.0±2.0）mm范围内不宜进刀,由此处向前至髌韧带间为前内侧进刀点.另在膝关节内侧中点之后（29.1±4.5）mm,与半膜肌、半腱肌腱止点间为后内侧微创进刀点.结论：膝冠状韧带位于半月板外周缘连于胫骨内、外侧髁外周缘,从膝关节上述三个点进刀是微创切断松解膝冠状韧带的理想部位.

Objective：To dissect and observe the structural characteristics of coronary ligaments within knee joint, in order to provide＇anatomic evidence for improving the movement of meniscus and loosening the coronary ligaments. Methods ：Thirty-two specimens of knee joints from adult corpses were detected. The ap- pearance, length and width of condyles of tibia, menisci and coronary ligaments were measured. Results： （ 1 ） the lateral menisci slided forward for 5.6 ± 1.3 mm and backward for 8.7 ± 1.7 mm. Simultaneously, the medial menisci slided forward for 5.5 ± 1.4 mm and backward for 7.4± 1.8 mm. （2） The lateral coronary ligament was 87.2 ± 9.6 mm in circumference , 15.4 ± 3.0 mm in width and 0.9 ± 0.3 mm in thickness. （3）The medial coronal ligament was 91.9 ± 7.9 mm in perimeter, 15.9 ± 3.2 mm in width and 0.8 ~ 0.2 mm in thick- ness. （4） The minor invasive entrance for the lateral coronary ligament was within 26.4 ± 3.7 mm ahead of the lateral mid-point of the knee joint. The region within 20.2 ± 5.8 mm outside of the anterior midpoint of the knee joint was not suitable for entrance. （5） The incorrect minor invasive entrance for the medial coronary liga- ment was within the scope of 7.0 ± 2.0 mm inside of the midpoint of the knee joint, but the region between the midpoint of the knee joint and the patellar ligament was suitable for the anteromedial minor invasive entrance. The scope within 29.1 ± 4.5mm behind the mid-point of the knee point, between the endpoints of the semiten- dinosus and semimembranosus, was the proper posteromedial minor invasive entrance. Conclusions：The coronary ligaments of knee joint locate at the peripheral edge of the meniscus and connect with the peripheral edge of the medial and the lateral condyle of tibia. Three above-mentioned minor invasive entrances of the knee joints are the ideal locations for cutting off and loosening the coronary ligaments.