中国成人前交叉韧带胫骨止点的解剖研究  

ANATOMICAL RESEARCH OF TIBIAL INSERTION OF ANTERIOR CRUCIATE LIGAMENT IN CHINESE ADULTS

作　　者：尤田[1] 张新涛[1] 张文涛[1] 江长青[1] 黄伟[1] 李伟[1] 张洪雷[1] 白露[1] 江小成 左建伟[1] 陈鹏[1] 任士友 

机构地区：[1]北京大学深圳医院运动医学与康复科,广东深圳518036

出　　处：《中国修复重建外科杂志》2015年第6期730-733,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 观测中国成人前交叉韧带（anterior cruciate ligament,ACL）胫骨止点的解剖学形态,为临床ACL或半月板手术提供理论指导。方法 取15具防腐处理成人膝关节标本,供体男10具,女5具;年龄25～47岁,平均32.4岁。左膝8具,右膝7具。采取标准髌旁内侧入路大体观察标本形态,然后对ACL实质部以及胫骨止点（分为直接止点和间接止点）进行解剖测量。结果 大体观察见,ACL呈扁平条状,由大量细纤维束组成,其中13个标本可见明显的前内束与后外束;2个标本无明显分束。ACL胫骨直接止点呈弧形,起自内侧髁间棘外侧面,止于外侧半月板前角的前方,宽度为（11.2±2.4）mm、厚度为（3.0±0.3）mm、横断面积为（28.8±7.8）mm2。完整胫骨止点左右径为（9.5±1.8）mm,前后径为（11.9±0.6）mm,横断面积（117.8±12.5）mm2。外侧半月板前角宽度为（12.3±2.0）mm。ACL胫骨直接止点将外侧半月板前角包绕其中,而胫骨间接止点纤维与外侧半月板前角纤维部分交织。结论 ACL重建时胫骨止点应尽量接近弧形重建。ACL与外侧半月板前角为交叉覆盖关系,在进行外侧半月板移植时应注意保护ACL胫骨止点。Objective To observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament （ACL） in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. Methods Fifteen adult cadaveric knees （8 left knees and 7 right knees） were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years （mean, 32.4 years）. All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion （direct and indirect insertions） were anatomically measured. Results In all specimens, the ACL was fiat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc- shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was （11.2±2.4） ram; the thickness was （3.0±0.3） mm; and the cross-sectional area was （28.8±7.8） mm2. And the left-right diameter of the whole insertion was （9.5± 1.8） ram; anteroposterior diameter was （11.9±0.6） ram; and the cross-sectional area was （117.8±12.5） mm2. The width of the anterior horn of lateral meniscus was （12.3±2.0） mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. Conclusion Anatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.

关 键 词：前交叉韧带 胫骨止点 解剖研究 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R687[医药卫生—基础医学]