PLC止点与ACL股骨隧道外口关系的影像学研究

A Radiographic Study on Relation between Posterior-Lateral Corner of Femoral Anatomic Insertion Site and Outside Mouth of Anatomic Femoral Tunnel in Anterior Cruciate Ligament Reconstruction

目的探讨后外侧角(PLC)股骨止点和前交叉韧带(ACL)解剖重建股骨隧道外口的位置,以获得详细的放射学资料,并为ACL和PLC一期解剖重建提供依据。方法采用30例成人尸体膝部标本。克氏针标记ACL股骨隧道,克氏针标记LCL、PT止点和股骨外上髁。在侧位X线片上建立以Blumensaat线为基准的矩形,用比率的方式测量ACL隧道外口、LCL和PT止点的位置。并以外上髁为原点建立坐标轴,测量各点的坐标及3点之间的距离。结果 ACL隧道外口均位于矩形外,LCL和PT止点中心均位于矩形内。LCL止点中心在股骨外上髁近端(1.27±3.35)mm、后方(2.99±1.29)mm。PT止点中心在股骨外上髁远端(8.85±3.38)mm、后方(3.83±1.95)mm。ACL股骨隧道外口在股骨外上髁近端(16.12±5.34)mm、前方(6.84±4.17)mm。LCL与PT止点中心相距(9.67±3.92)mm,ACL股骨隧道外口与LCL止点中心相距(13.07±4.93)mm,ACL股骨隧道外口与PT止点中心相距(23.37±6.16)mm。结论揭示了LCL、PT的股骨解剖中心点和ACL股骨隧道外口位置的解剖影像学特点,为临床一期联合解剖重建提供了影像学基础。

Objective To measure the position of posterior-lateral corner of femoral insertion site and outside mouth of femo- ral tunnel in anterior cruciate ligament anatomical reconstruction, obtain detailed radiological anatomy date, thus provide anatomi-cal basis for one-stage anterior cruciate ligament （ACL） and posterior eruciate ligament （PCL） anatomical reconstruction. Meth-ods We used 30 cases adult cadaverie knee specimens. The femoral tunnel in anterior cruciate ligament reconstruction, the in-sertion site of lateral collateral ligament（LCL） and popliteus tendon（PT） were identified and marked with K-wire. The position of ACL femoral tunnel external mouth, LCL and PT check point were recorded as a ratio pattern on a modified reticule which was es-tablished on lateral femoral X-rays wlui the Blumenasst＇ s line as the base reference. We set the femoral epicondyle as the origin, establish （x, y） vertical axis to measure the coordinate of femoral anatomical insertion site of LCL, PT and outside mouth of ACL femoral tunnel. Then we measured the distance between these three points. Results On the lateral femoral X-ray films, the inser- ion site of the LCL and PT were located respectively on the reticule at （ 14.80 ± 5.76 ） %, （ 38.06 ± 4.60 ） % and （ 9.85 ± 6.86）%, （48.27 ±8.01 ）%. The LCL insertion site was located at a mean distance of （1.27 ± 3.35 ） mm proximally and （2.99 ±1.29） mm posteriorly to the lateral epicondyle. The PT insertion site was located at a mean distance of （8.85 ± 3.38 ） mm distally and （ 3.83 ± 1.95 ） mm posteriorly to the lateral epicondyle. The ACL femoral tunnel external mouth was located at a mean distance of （ 16.12 ± 5.34） mm proximally and （ 6.84 ± 4.17 ） mm anteriorly to the lateral epicondyle. The distance be-tween LCL and FF insertion site was （ 9.67 ± 3.92） ram, ACL femoral tunnel external mouth and LCL insertion site was （13.07 ±4.93 ） mm ,ACL femoral tunnel external mouth and PT insertion site was （23.37 ± 6.16 ） mm. Conclusion The ana-tomic characteristic of femoral insertion site center of LCL and PT and ACL femoral tunnel external mouth was revealed, which provides an anatomic basis for one-stage clinical combination reconstruction.