膝关节前交叉韧带止点足印区的应用解剖学观测

Applied anatomic observation on the footprint of the anterior cruciate ligament

目的:明确苏南地区人群前交叉韧带(anterior cruciate ligament,ACL)足印区的相关数据,以便能为该地区ACL解剖重建术式的选择提供参考。方法:选取12具尸体共24个膝关节(为甲醛浸泡标本),去除ACL后研究其胫骨及股骨止点足印区,辨识解剖标志并用游标卡尺测量,记录相关数据并通过数码相机拍摄。结果:胫骨上端横径为(71.65±5.96)mm,前后径为(43.42±3.80)mm;胫骨止点长度为(15.18±2.65)mm,宽度为(7.54±1.12)mm;股骨止点长度为(14.78±2.52)mm,宽度为(9.20±1.62)mm;股骨止点与后壁的距离为(2.74±0.63)mm,外侧髁间嵴出现率为75%(18/24),外侧二分嵴出现率为48%(11.5/24)。上述指标左右膝数据比较,差异均无统计学意义,证明实验测量可靠。结论:我国苏南地区ACL止点足印区的长度及宽度均较小,推荐使用单束解剖重建术,在术中无法精确测量止点足印区宽度的条件下,移植物的直径推荐为8 mm以下;外侧髁间嵴出现较为恒定,可以作为解剖重建的标志。

Objective： To collect the antheropometric data on footprint area of the anterior cruciate ligament（ ACL） among populations in South Jiangsu area,so as to provide a theoretical basis for surgical options in ACL reconstruction. Methods： Twelve corpses（ a total of 24 knee joints） were selected for formalin-fixed specimens. After removal of the ACL,footprint area was investigated,with anatomical landmarks identified and related data on the tibia and the femoral footprint measured using a vernier caliper. The data were recorded and photographed by a digital camera. Correlations among above data were analyzed. Results： Transverse diameter and anteroposterior diameter of the tibial plateau was（ 71. 65 ±5. 96） mm and（ 43. 42 ± 3. 80） mm,respectively. Length and width of tibial insertion was（ 15. 18 ±2. 65） mm and（ 7. 54 ± 1. 12） mm,respectively. Length and width of femoral insertion was（ 14. 78 ±2. 52） mm and（ 9. 20 ± 1. 62） mm,respectively. The distance between the femoral insertion and the posterior wall was（ 2. 74 ± 0. 63） mm. The incidence of lateral intercondylar ridge was 75%（ 18/24） and the incidence of lateral bifurcate ridge was 48%（ 11. 5/24）. Among above indicators,data of the left and right knee were showed no significant differences. Conclusion： Due to minor length and width of the foot print,single-bundle anatomical reconstruction should be recommended in the treatment of ACL injury in South Jiangsu area in China. With width unable to be accurately measured intraoperatively,the diameterof transplant should be recommended to be less than 8 mm. The occurrence of lateral intercondylar ridge is stable and could be used as a landmark of anatomical reconstruction.