膝关节后外侧复合体重建术的应用解剖学及生物力学研究

APPLIED ANATOMIC AND BIOMECHANICAL STUDY ON RECONSTRUCTION OF POSTEROLATERAL COMPLEX OF KNEE

目的通过对正常成人膝关节后外侧结构的应用解剖学及生物力学研究,为膝关节后外侧复合体重建术中骨隧道定位及移植物的选择提供实验依据。方法取自愿捐献的成人新鲜下肢截肢标本23个,防腐下肢标本9个,解剖观察并测量标本膝关节后外侧复合体主要结构,获取解剖学量化指标。取其中6个新鲜标本的腘肌腱、外侧副韧带和腘腓韧带进行生物力学实验,测定其最大抗张强度及载荷。结果腘肌肌肉-肌腱移行处位于胫骨平台下7.02～11.52mm,腓骨头尖内侧8.22～13.94mm。腘肌腱股骨止点距股骨外髁下缘10.52～14.38mm,距股骨外髁后缘14.24～26.18mm。腘腓韧带起自腘肌肌肉-肌腱移行处,腓骨止点位于腓骨头尖稍内侧。外侧副韧带腓骨端附着点位于腓骨头尖下方10.54～16.48mm,股骨止点距股骨外髁下缘14.92～19.62mm,距股骨外髁后缘14.66～27.08mm。腘肌腱最大抗牵张载荷为579.60～888.40N,最大抗牵张强度为20.50～43.70MPa;外侧副韧带分别为673.80～1003.20N及24.30～56.40MPa;腘腓韧带分别为101.56～567.35N及8.94～36.16MPa。结论解剖重建膝关节后外侧复合体骨隧道定位,以股骨外髁、腓骨头及胫骨平台作解剖标志,依照相应测量值可进行精确定位。而选择移植物其最大抗牵张载荷应>833N,最大抗牵张强度应>36MPa。

Objective To provide the anatomic evidences and the choice of tendon graft for anatomic reconstruction of posterolateral complex through the morphological and biomechanical study on posterolateral structures of the knee in normal adult cadavers. Methods Twenty-three fresh lower limb specimens from voluntary donators and 9 lower limbs soaked by Formalin were selected for anatomic study on the posterolateral complex of the knee. Six fresh specimens were applied to measure the maximum load, intensity of popliteus tendon, lateral collateral ligament, and popliteofibular ligament, which were key components of the posterolateral complex. Results Popliteus musculotendinous junction was located at 7.02-11.52 mm beneath lateral tibial plateau and 8.22-13.94 mm medially to fibular styloid process. The distances from femoral insertion of popliteus tendon to the lower border of femoral condyle and to posterior edge of femoral condyle were 10.52-14.38 mm and 14.24-26.18 ram, respectively. Popliteofibular ligament originated from popliteus musculotendinous junction and ended at fibular styloid process. Lateral collateral ligament was located at 10.54-16.48 mm inferior to fibular styloid process, and the distances from femoral insertion to the lower border of femoral condyle and to posterior edge of femoral condyle were 14.92-19.62 mm and 14.66-27.08 ram, respectively. The maximum load and intensity were 579.60-888.40 N and 20.50-43.70 MPa for popliteus tendon, were 673.80-1 003.20 N and 24.30-56.40 MPa for lateral collateral ligament, and were 101.56-567.35 N and 8.94-36.16 MPa for popliteofibular ligament, respectively. Conclusion During anatomical reconstruction ofposterolateral complex, the bony tunnel of the key components should be located according to the insertion mentioned above. On the basis of this study, the maximum load and intensity of selectable grafts should exceed 833 N and 36 MPa.