腓肠肌起点解剖观察及其在全膝关节置换术中的意义

Anatomical observation of origins of the gastrocnemius and its significance in total knee arthroplasty

目的：研究腓肠肌起点的解剖学特点，探讨其在严重屈曲挛缩畸形全膝关节置换术（TKA）中的意义。方法：常规解剖20侧防腐及2侧新鲜成人膝关节标本，观测腓肠肌起点的形态结构及其与周围结构的毗邻关系。结果：腓肠肌内、外侧头起点分为中间的肌性部分和两侧的腱性部分。外侧头起始部的腓后侧有股二头肌肌腱及腓总神经斜跨过，腓侧有胭肌腱及外侧副韧带。内侧头起始部的胫后侧有半腱肌和半膜肌肌腱。膝上内、外侧动脉从腓肠肌内、外侧头起点上方贴着骨膜绕过股骨内、外侧髁到前方。腓肠肌腱性部分周围无重要神经血管毗邻，为解剖安全区。结论：严重屈曲挛缩畸形TKA术中，常规经侧副韧带内侧的松解方式只能松解到肌性部分，可能是松解不够彻底的原因之一。

Objective： To study the anatomical characteristics of origins of the gastrocnemius and explore its significance in total knee arthroplasty for the knee joint with severe flexion deformity. Methods： Two fresh and 20 embalmed knee joints were dissected to observe the morphological structures of origins of the gastrocnemius and the relationships with their adjacent tissues. Results： The medial and lateral heads of the gastrocnemius consisted of middle muscular part and bilateral tendinous parts. The tendon of biceps femoris and common peroneal nerve crossed behind the fibular back of the beginning part of the lateral head. And, there were tendon of the popliteus and lateral collateral ligament on its fibular side. The tendons of the semitendinosus and semimembranosus were posterior to the tibial side of the beginning part of the medial head. The me- dial and lateral superior genicular arteries coursed above the origins of the medial and lateral heads of the gastrocnemius, then, bypassed the medial and lateral condyles and run forwardly. The area surrounding the tendon of gastrocnemius is an anatomical safe zone without important nerves and blood vessels. Conclusion： In total knee arthroplasty for the knee joints with severe flexion deformity, the conventional release through the collateral ligament only reaches the muscular part,which may be a cause of an incomplete release.