本文選題：膝關(guān)節(jié) + 外側(cè)副韌帶��； 參考：《河北醫(yī)科大學(xué)》2009年碩士論文

【摘要】： 目的:對(duì)人膝后外側(cè)復(fù)合結(jié)構(gòu)( posterior lateral complex;PLC)的解剖進(jìn)行觀察研究,為臨床診治提供解剖學(xué)基礎(chǔ)。 方法:選擇8例人膝關(guān)節(jié)標(biāo)本,排除膝關(guān)節(jié)損傷、腫瘤等疾患,解剖膝關(guān)節(jié)后外側(cè),辨認(rèn)后外側(cè)各結(jié)構(gòu)起止點(diǎn)及走行,明確它們之間的解剖關(guān)系。對(duì)標(biāo)本外側(cè)副韌帶(LCL)、乆肌腱復(fù)合體、乆腓韌帶走行進(jìn)行測(cè)量,計(jì)算各肌腱及韌帶在不同平面上與腓骨長(zhǎng)軸所形成的夾角,并對(duì)PLC各主要結(jié)構(gòu)的抗旋轉(zhuǎn)作用做生物力學(xué)測(cè)定。 結(jié)果:膝關(guān)節(jié)后外側(cè)包括三層結(jié)構(gòu),淺層包括髂脛束和股二頭肌腱;中間層包括髕骨外側(cè)支持帶、髕股韌帶、腓腸肌外側(cè)頭;深層由沿外側(cè)半月板邊緣附著的外側(cè)關(guān)節(jié)囊、LCL、乆肌腱復(fù)合體、乆腓韌帶、豆腓韌帶、弓狀韌帶、后交叉韌帶(PCL)、板股韌帶等組成。 髂脛束起于髂前上嵴,止于脛骨外側(cè)平臺(tái)Gerdy結(jié)節(jié)。髂脛束可分為淺層、深層和被膜骨性層。分離淺層后可見深層纖維緊密粘附于股骨外上髁并續(xù)于骨外側(cè)肌間隔。其被膜骨性層起于外側(cè)肌間隔和腓腸肌、跖肌后外側(cè)筋膜,與股二頭肌短頭腱膜相延續(xù)。 股二頭肌腱下行至髂脛束后方,有長(zhǎng)、短兩個(gè)頭,每個(gè)頭又分為前支和直支。長(zhǎng)頭和短頭直支與LCL以聯(lián)合腱共同止于腓骨頭外側(cè)基底部;短頭前支與外側(cè)關(guān)節(jié)囊中三分之一共同止于脛骨上外側(cè)面。腓總神經(jīng)在股二頭肌肌腱的后方深層,位于腓骨莖突遠(yuǎn)端1.5～2.0cm處。 腓腸肌外側(cè)頭起于LCL起點(diǎn)后方,沿乆肌腱后方向遠(yuǎn)側(cè)走行。腓腸豆是腓腸肌腱外側(cè)頭內(nèi)的一個(gè)不確定存在的籽骨,腓腸豆腓骨韌帶也不確定存在。本組8膝中發(fā)現(xiàn)有3膝存在腓腸豆。 髕外側(cè)支持帶,起于髕骨外側(cè)緣,止于脛骨近端外側(cè)面。髕股韌帶位于髕骨外側(cè)支持帶近端,起于髕骨外側(cè)緣,止于股骨外側(cè)髁。 LCL起于外側(cè)股骨髁的外側(cè)粗隆,起點(diǎn)位于腓腸肌腱外側(cè)頭股骨附著點(diǎn)的前方,并向遠(yuǎn)側(cè)延伸斜越過腓腸肌腱,在髂脛束后方下行,與股二頭肌腱以聯(lián)合肌腱的方式聯(lián)合止于腓骨頭外側(cè)方。 乆肌起于脛骨近端后內(nèi)側(cè),逐漸延伸并于外側(cè)形成一根肌腱繼續(xù)通過乆肌裂孔進(jìn)入膝關(guān)節(jié),在外側(cè)股骨髁乆溝內(nèi)移行,從LCL下方穿過,止于股骨外側(cè)髁粗隆,形成乆肌腱復(fù)合體。沿途發(fā)出分支至外側(cè)半月板后角和腓骨莖突,分別形成乆半月板韌帶和乆腓韌帶。 乆腓韌帶起于乆肌與腱連接處附近向遠(yuǎn)端和外側(cè)走行,附著于腓骨莖突的內(nèi)側(cè)面,這條韌帶短,腱強(qiáng)韌甚至比乆肌腱還要寬大。弓狀韌帶是一條呈“Y”形結(jié)構(gòu)的關(guān)節(jié)囊增厚部分,分為內(nèi)、外側(cè)支,兩支插入腓骨莖突頂端,正好位于豆腓韌帶前方。內(nèi)側(cè)支彎曲越過乆肌和腱,與乆斜韌帶匯合;外側(cè)支沿關(guān)節(jié)囊上升,與外側(cè)腓腸肌股骨髁止點(diǎn)附近關(guān)節(jié)囊融合。 PCL起于股骨內(nèi)側(cè)髁外側(cè)面,向下后外方向走行,止于脛骨髁間棘后部。PCL表面覆蓋有一層滑膜組織,滑膜鞘內(nèi)有血管走行。在PCL與前交叉韌帶(ACL)相交叉處,有類似于脂肪的組織將兩根韌帶相連,較為疏松。根據(jù)韌帶纖維的起止部位,大體標(biāo)本上PCL可分為前外束和后內(nèi)束。 板股韌帶一般有一或兩根,起于股骨內(nèi)髁,止于外側(cè)半月板后角。位于PCL前方的稱Humphrey韌帶,位于PCL后方的稱Wrisberg韌帶。 各主要肌腱及韌帶在不同平面上與腓骨長(zhǎng)軸所形成的夾角:矢狀面LCL為10°左右;冠狀面乆腓韌帶約29°左右;矢狀面乆肌腱關(guān)節(jié)囊內(nèi)部分51°左右;關(guān)節(jié)囊外部分44°左右。 生物力學(xué)試驗(yàn)表明,膝關(guān)節(jié)后外側(cè)的旋轉(zhuǎn)穩(wěn)定性由PLC的不同結(jié)構(gòu)共同維持,在不同的屈膝角度,主要由不同的PLC結(jié)構(gòu)提供。 結(jié)論:人膝PLC結(jié)構(gòu)復(fù)雜,大體分為三層結(jié)構(gòu)。廣義上的PLC結(jié)構(gòu)包括組成膝關(guān)節(jié)后外側(cè)的所有肌腱、韌帶等結(jié)構(gòu),狹義上指后外側(cè)角,即LCL、乆肌腱復(fù)合體、乆腓韌帶和后外側(cè)關(guān)節(jié)囊。通常將股二頭肌腱、LCL、乆肌腱復(fù)合體、乆腓韌帶看作是膝關(guān)節(jié)后外側(cè)的主要結(jié)構(gòu),解剖中發(fā)現(xiàn)膝關(guān)節(jié)后外側(cè)各結(jié)構(gòu)間關(guān)系密切,相互之間連接成為一個(gè)整體,對(duì)膝關(guān)節(jié)后外側(cè)發(fā)揮穩(wěn)定、保護(hù)的作用,其中LCL、乆肌腱復(fù)合體和乆腓韌帶結(jié)構(gòu)最重要,這三個(gè)結(jié)構(gòu)在膝關(guān)節(jié)后外側(cè)形成一個(gè)穩(wěn)固的三角形,有防止膝關(guān)節(jié)內(nèi)翻、脛骨外旋和脛骨后墜的作用。生物力學(xué)試驗(yàn)表明,膝關(guān)節(jié)后外側(cè)旋轉(zhuǎn)穩(wěn)定性主要由LCL、乆肌腱復(fù)合體提供,而PCL則是重要的輔助抗外旋結(jié)構(gòu)。在不同的屈膝角度,膝關(guān)節(jié)后外側(cè)的旋轉(zhuǎn)穩(wěn)定性分別由不同的PLC結(jié)構(gòu)提供。熟悉PLC的解剖特點(diǎn)有助于利用X線片、CT或MRI表現(xiàn)對(duì)PLC的損傷作出正確診斷,也為臨床上采取的修復(fù)或重建手術(shù)提供解剖學(xué)依據(jù)。
[Abstract]:Objective : To observe the anatomy of posterior lateral complex ( PLC ) and provide anatomical basis for clinical diagnosis and treatment .



Methods : Eight specimens of knee joint were selected to remove knee joint injury , tumor and other diseases . The anatomical relationship between them was determined . The included angle between each tendon and ligament and the long axis of fibula was calculated .



Results : The outer side of the knee joint comprises three layers of structure , the superficial layer includes the external iliac tibial band and the femoral head tendon ; the middle layer comprises the outer supporting belt of the patella , the patella ligament and the lateral head of the fibula muscle ; the deep layer consists of an outer joint capsule which is attached to the edge of the lateral meniscus ;



Iliotibial tract begins on the anterior superior iliac crest and terminates at the Gerdy nodules on the lateral tibial plateau . The iliac tibial band can be divided into superficial , deep , and membranous bony layers . The superficial layers of the superficial layer are closely adhered to the medial femoral condyle after separation of the superficial layer .



One third of the long head and the short head straight branch are common to the lateral basal part of the fibula head , and one third of the short anterior branch and the outer joint capsule are common to the outer lateral surface of the tibia .



It was found that there were 3 knees in the knee .



The Patellofemoral ligament is located on the outer side of the patella and terminates at the outer lateral surface of the proximal tibia . The patellar ligament is located on the outer side of the patella supporting the proximal end of the patella and acts on the lateral margin of the patella and terminates at the lateral condyle of the femur .



The lateral femoral condyle was located on the lateral side of the lateral femoral condyle . The origin was located in the anterior part of the femoral attachment point on the lateral head of the distal femur and extended obliquely across the tendon of the fibula to the distal side .



The medial side of the proximal tibia of the tibia , gradually extending and forming a tendon on the outer side , continues to enter the knee joint through the muscular rupture of the femur , and passes through the lateral femoral condyle groove , passes through the lateral condyle of the femur , and forms a tendon complex . The posterior horn of the lateral meniscus and the styloid process of the fibula are transmitted along the way to form the meniscus ligament and the transpepal ligament respectively .



The collateral ligament is a thickened part of the joint capsule of " Y " - shaped structure , which is divided into inner and outer branches , and the two branches are inserted into the top of the pedicle of the fibula . The medial branch bends over the muscle and the tendon and joins with the oblique ligament . The lateral branch rises along the joint capsule , and is fused with the joint capsule near the condyle stop point of the lateral fibula muscle .



The PCL is located on the lateral surface of the medial condyle of the femur , and runs in the posterior direction . The PCL surface is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . The surface of the PCL is covered with a layer of synovial tissue . At the intersection of the PCL and the anterior cruciate ligament ( ACL ) , there is a tissue similar to the fat that connects the two ligaments , and is loose . According to the starting position of the ligament fiber , the PCL in the general specimen can be divided into a front outer beam and a rear inner beam .



The plate femoral ligament typically has one or two , starting from the medial femoral condyle , ending at the posterior horn of the lateral meniscus . The anterior tibial ligament is located in the anterior portion of the PCL and is located posterior to the PCL as the Wrisberg ligament .



The included angle of each major tendon and ligament with the long axis of fibula is about 10 擄 in sagittal plane , about 29 擄 in coronal plane , 51 擄 in sagittal plane , and 44 擄 out of joint capsule .



Biomechanical tests show that the rotational stability of the posterior lateral knee of the knee joint is maintained by the different structures of the PLC , and is mainly provided by different PLC structures at different knee angles .



Conclusion : The human knee PLC has a complex structure and is generally divided into three layers . The generalized PLC structure consists of all tendons , ligaments and other structures which form the outside of the knee joint .
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R687.3;R322

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 張建林;葉軍;欒彥軍;魏塞;趙俊華;;自體半腱肌、股薄肌重建術(shù)治療急性膝關(guān)節(jié)前交叉韌帶合并后外側(cè)角損傷[J];山東醫(yī)藥;2012年10期

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本文編號(hào)：2057918