后交叉韧带双束重建时隧道定位的解剖学研究

Anatomic landmarks for femoral tunnel positioning in double-bundle posterior cruciate ligament reconstruction

目的膝关节是人体最大和最重要的下肢承重和运动关节,而膝关节后交叉韧带是膝关节最强的韧带,是稳定膝关节最重要的结构。但是后交叉韧带双束重建时,股骨和胫骨隧道具体定位标准尚缺乏统一认识。而合理确认后交叉韧带双束双隧道有利于指导治疗,提高后交叉韧带重建的效果。本文探讨后交叉韧带两束的组成特点,分析双束重建时隧道定位的解剖学效果。方法选择成人尸体膝关节标本20具,首先进行前外束与后内束的相关解剖学测量,同时选择力学试验仪在完整标本、切断后交叉韧带和双束重建时间点完成后进行胫骨后移距离的测定。结果经过测量,后内束至前缘的距离、至髁间窝顶的距离、至关节面的距离明显多于前外束,同时其平行于股骨干轴的时钟范围、平行于Blumensaat线的时钟范围、横截面积明显少于前外束,差异都有统计学意义(P<0.05)。前外束与后内束的至内侧缘的距离对比差异无统计学意义(P>0.05)。完整的膝关节在屈伸过程中,胫骨后移距离不超过4.0 mm;切断后交叉韧带后,胫骨后移距离有明显增加(P<0.05);不过在重建后,胫骨后移距离基本恢复到了完整的膝关节状态。结论从解剖结构上的角度来讲,后交叉韧带的双束重建符合生理于解剖学要求,有助于增加后交叉韧带双束重建手术的可重复性,从而保证手术效果。

Objective To investigate the properties of the two bundles of the human posterior erueiate ligament （PCL） and explore the anatomic landmarks for femoral tunnel positioning in double-bundle PCL reconstruction. Methods 20 adult cadaveric knees were selected, the anatomical measurements for anterolateral bundle （ALB） and posteromedial bun- dle（PMB） were obtained. The tibia setback distance was measured in the times of complete specimens,cut and double- bundle posterior eruciate ligament reconstruction. Results The distances from posteromedial bundles to leading edge, the top of the intercondylar fossa and the articular surface were longer when compared with the distances from anterolateral bundles to those points. The o＇ clock positions parallel to the femoral shaft and the femoral notch roof（ Blumensaat＇ s line on X-ray ） , and the cross sectional area for posteromedial bundles were significantly less than anterolateral bundles, the differences was statistically significant （ P 〈 0.05 ）. The distance to the medial border from the anterolateral bundle and tYom the posteromedial bundle had no significant difference（ P 〉 0.05 ）. The range of posterior tibial translation in the nor- mal knee was not more than 4.0 ram,and increased significantly in a knee in which PCL was cut（P 〈0.05）. After the double-bundle PCL reconstruction, the range of posterior tibia1 translation recovered. Conclusion From the anatomical point of view, the double-bundle PCL reconstruction meet the anatomy and physiology requirements, the appropriate ana- tomic landmarks for femoral tunnel positioning will increase surgery repeatability and guarantee outcome.