膝关节前交叉韧带胫骨止点的软组织解剖标记

Soft tissue landmarks of tibial attachment of anterior cruciate ligament

背景:膝关节前交叉韧带(ACL)重建时,胫骨骨道定位不准会产生重建韧带与髁间窝的撞击或起不到维持膝关节稳定性的作用。因此,确定ACL胫骨止点的位置非常重要。目的:研究膝关节ACL胫骨止点前内束(AMB)和后外束(PLB)与软组织标记后交叉韧带(PCL)和外侧半月板前角的距离,从而明确ACL胫骨止点在胫骨平台的位置,为ACL损伤双束重建提供理论支持。方法:解剖18个膝关节尸体标本(左膝10个,右膝8个),测量ACL中点、AMB中点、PLB中点与PCL和外侧半月板前角的距离,并分析左、右膝关节是否存在差异。结果:AMB中点与PCL和外侧半月板前角的距离分别为(15.00±3.97)mm和(19.78±4.10)mm;PLB中点与两者的距离分别为(10.17±5.56)mm和(19.50±4.40)mm;ACL中点与两者的距离分别为(12.67±4.52)mm和(19.61±3.87)mm。左右膝关节ACL中点、AMB中点、PLB中点与软组织解剖标记的距离无明显统计学差异。结论:膝关节ACL损伤行手术重建时,可采用PCL和外侧半月板前角作为定位标记。

Background： The inaccuracy of tibial tunnel position in anterior cruciate ligament（ACL） reconstruction will cause impingement between the graft and intercondylar notch and also lead to instability of the knee. Therefore, it is very important to choose a proper tibial insertion site.Objective： To investigate the tibial anatomy of the anteromedial and posterolateral bundles, and to provide a guideline during double-bundle ACL reconstruction.Methods： The position of tibial attachment of the centre of ACL, anteromedial and posterolateral bundles relative to soft tissue landmarks were measured in 18 cadaveric knees. The difference between left and right knees was compared.Results： The distance between the center of anteromedial bundle and PCL, and anterior root of the lateral meniscus was（15.00±3.97） mm and（19.78±4.10） mm. The distance between the center of posterolateral bundle and PCL, and anterior root of the lateral meniscus was（10.17±5.56） mm and（19.50±4.40） mm. The distance between the center of ACL and PCL,and anterior root of the lateral meniscus was（12.67±4.52） mm and（19.61±3.87） mm, respectively. There were no significant differences in the distance between the centers of ACL, anteromedial bundle, posterolateral bundle and soft tissue landmarks between knees.Conclusions： The anterior root of the lateral meniscus and PCL can provide easily identifiable accurate reference points during ACL reconstruction for knee injury.