半月板损伤新型手术径路的解剖学研究

The Anatomical Study of New Surgical Approach on Meniscus Injury

目的分析膝关节内、外侧横形径路在半月板损伤治疗中的有效性和安全性。方法成人尸体标本5具,左右膝共10侧,均行膝关节内、外侧横形径路解剖,解剖过程中测量重要解剖结构参数。并将此径路应用于临床,手术治疗半月板损伤患者7例,术前Lysholm评分为23.86±4.38。结果膝关节内、外侧横形径路内的重要血管、神经结构少,主要有髌下支,膝上、下内侧动脉,膝上、下外侧动脉和胫前返动脉。髌下支穿出深筋膜后沿膝内侧下行跨越膝关节后部,距髌韧带内侧缘(38.76±0.81)mm;其主要动脉穿出深筋膜后,在膝周、径路上下方相互吻合成血管网。经单一内或外侧横形径路即可显露膝关节内或外侧半月板。临床治疗半月板损伤患者7例均获成功,经平均7年随访,术后Lysholm评分为87.86±4.14,明显高于术前(P<0.01)。根据Molster法评价其优良率达100%,其中优4例,良3例。结论经解剖学证实膝关节内、外侧横形径路具有损伤小、安全性高、解剖结构简单、暴露直接等优点,是治疗半月板损伤的有效径路。

Objective To analyze the efficacy and safety of the exterior and interior transverse approach of the knee joint in the treatment of meniscus injury.Methods Five adult specimens of corpse（ten lateral knees） were performed by the exterior and interior transverse anatomical pathway.The important parameters of the anatomical structures were measured in the process of the anatomy.Results There were less of the important vascular and neural structures within the exterior and interior transverse approach of the knee joint,mainly included of infrapatellar branch,medial superior genicular artery,medial inferior genicular artery,lateral superior genicular artery,lateral inferior genicular artery and anterior tibial recurrent artery.The infrapatellar branch pierced the deep fascia along the medial knee down across the back of the knee joint from the medial patellar ligament（38.76±0.81） mm.The main arteries were out of deep fascia,surrounding or trailing the knee to form the vascular network.By a single transverse rectus or lateral approach it could reveal the inside or lateral meniscus of the knee joint.Conclusion It is confirmed by the anatomy that the exterior and interior transverse approach has the advantages of mini-injury,safety,simple anatomical structure and direct exposure which is recommended as the effective approach of the treatment of meniscus injury.