膝关节前交叉韧带胫骨止点的骨性定位标记

The Bony Landmarks of ACL on Tibial Insertion

目的:研究膝关节前交叉韧带(ACL)胫骨止点及其前内束(AM束)和后外束(PL束)与其骨性定位标记(胫骨内侧髁间棘、over-the-back缘以及胫骨平台前后缘)的距离。方法:分别测量18个膝关节(左膝关节10个,右膝关节8个)ACL中点、AM束中点和PL束中点与三个解剖标记的距离,并比较左、右膝关节有无差异。所有操作均由同一人完成。结果:ACL束中点与胫骨内侧髁间棘和over-the-back缘的距离分别为9.94±2.84 mm和15.06±3.93 mm;AM束中点与二者的距离分别为7.50±2.45 mm和16.83±2.94 mm;PL束与二者的距离分别为11.39±2.25 mm和14.94±4.11 mm。左、右膝关节的AM束和PL束中点距离over-the-back缘距离差异有统计学意义。ACL中点位于胫骨平台前后缘的40.18%±3.08%处。结论:胫骨内侧髁间棘和over-the-back缘术中易于定位,可以作为ACL重建时的骨性定位标记,但左、右膝关节有差异。

Objective To investigate the distances from the center of ACL, anteromedial（AM）bundle and posterolateral（PL）bundle of ACL to the bony landmarks of tibial insertion. Methods The distances from centers of ACL, AM bundle and PL bundle to the bony landmarks of tibial insertion（＂over-the-back＂ridge,medial tibial spine and tibial plateau）were measured in 18 cadaveric knees,and compared between the left and right knees. Results The distances from the spine of tibial medial condyle and the ＂over-the-back＂ ridge to the center of ACL were 9.94 ± 2.84 mm and 15.06 ± 3.93 mm,to the center of AM bundle were 7.50 ±2.45 mm and 16.83 ± 2.94 mm,and to the center of PL bundle were 11.39 ± 2.25 mm and 14.94 ± 4.11 mm,respectively. The distances from centers of AM bundle and PL bundle to the ＂over-the-back＂ ridge were significantly different between the left and right knees. The distances from the center of ACL to the anterior and posterior edges of the tibial plateau were 19.40 ± 2.20 mm and 8.90 ± 3.40 mm,respectively.Conclusions The ＂over-the-back＂ ridge and medial tibial spine were easily to be identified during the surgical procedure,in spite of the existence of the different distances from the bundles to the ＂over-the-back＂ ridge.