伸膝装置应用解剖及其在膝关节置换术中的临床意义  

Clinical anatomy of extensor mechanisim of the knee joint and its significance in total knee arthroplasty

作　　者：余正红[1] 李义凯[2] 赵卫东[1] 李忠华[1] 张美超[1] 钟世镇[1] 

机构地区：[1]南方医科大学临床解剖学研究所,广东省医学生物力学重点实验室 [2]南方医科大学中医药学院骨伤教研室,广州510515

出　　处：《中国临床解剖学杂志》2007年第5期489-492,496,共5页Chinese Journal of Clinical Anatomy

基　　金：国家自然科学基金(30371449);广东省自然科学基金(04300684)

摘　　要：目的:为全膝关节置换术(TKA)中髌骨软组织平衡提供形态学基础。方法:应用显微外科技术对12例新鲜、80例固定成人膝关节标本伸膝装置的解剖结构进行观察与测量。结果:髌前三层不同走向的纤维膜性结构包被伸膝装置。股外侧肌腱、股内侧肌、股最内侧肌与股直肌腱分别成33.50°±6.19°、54.5°±8.20°、78.60°±8.52°角。矢状面股直肌腱与髌腱成12°(3°～20°)夹角。股四头肌腱扩张部向下扩展形成髌内、外侧支持带(MPR、LPR)。内侧髌股韧带(MPFL)长(47.60±5.59)mm,宽(19.70±6.13)mm。膝关节肌为独立肌肉,是膝关节重要的滑移装置并维持髌骨内侧稳定结构。结论:TKA术中髌骨软组织平衡,关键在于准确分层缝合股最内侧肌止点和MPFL,必要时松解髌骨外上角股外侧肌腱或LPR。术中防止膝关节肌内侧束撕裂有重要意义。Objective： To provide morphologic dam for the realignment of the extensor mechanism of the knee joint in total knee arthroplasty （TKA）. Methods： To measure and observe anatomic structures on 12 fresh adult human cadaveric knees and 80 formaldehyde-fixed ones with microsurgical techniques. Results： The extensor mechanism was wrapped up by trilaminar prepatellar fibrous soft tissues with different arrangement. The angles of the vastus lateralis tendon and the vastus medialis obliquus muscle （VMO） fibers to the rectus tendon were 33.5° and 78.6°, respectively. In sagittal plane, a angle about 12°（3° -20°）between the rectus femoris tendon and the patellar tendon was observed. The pavilion of quadriceps tendon spread downward and formed the lateral and medial patellar retinaculum.The medial patellofemoral ligament （MPFL） was （47.60± 5.59）mm long and （19.70±6.13） mm wide. The subcrureus was an independent muscle which acted as a frift structure and a medial stabilizer of patellar. Conclusions： The key procedure of soft tissue balancing in TKA was to suture the VMO and MPFL accurately, and loose the vastus lateralis tendon or the lateral patellar retinaculum if necessary. Protection of the subcrureus is significant in TKA.

关 键 词：伸肌装置 全膝关节置换术 内侧髌股韧带 髌股关节失稳 

分 类 号：R323.72[医药卫生—人体解剖和组织胚胎学]