重建膝前交叉韧带取自体腘绳肌肌腱安全区域的临床解剖学参数  

A study of a safe area and angle for harvesting autogenous hamstring tendons for anterior cruciate ligament reconstruction

作　　者：陈英华 韦庆军[2] 姚军[2] Chen Yinghua;Wei Qingjun;Yao Jun(Langdong Hospital Affiliated to Guangxi Medical University,Nanning 530029,Guangxi Zhuang Autonomous Region,China;First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学附属埌东医院,广西壮族自治区南宁市530029 [2]广西医科大学第一附属医院,广西壮族自治区南宁市530021

出　　处：《中国组织工程研究》2019年第30期4822-4827,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:自体腘绳肌移植重建前交叉韧带越来越受到术者的重视,术后发现有一部分患者膝前及小腿前内侧感觉异常,这是因为术中切取腘绳肌腱时隐神经或隐神经髌下支损伤所致。目的:通过解剖膝关节来确定手术切口的安全区域和角度,在获取股薄肌和半腱肌肌腱时尽可能避免损伤隐神经及隐神经髌下支。方法:选择膝关节新鲜标本10例,均为截肢患者肢体,签署手术知情同意书,试验方案得到医院伦理委员会批准。分离出隐神经及其髌下支分支。以髌韧带在胫骨结节止点的内缘处定为标志点A,经A点做一条水平线,与隐神经主干的交点定为标志点C,与隐神经髌下支的交点定为标志点B。分别测量标志点A至标志点C的距离AC和标志点A至标志点B的距离AB。通过分析和统计学计算得出手术安全区范围和切口角度。结果与结论:①手术切口安全范围:A至隐神经(C点)的距离AC为(5.5±0.3)cm,A至隐神经髌下支(B点)的距离AB为(3.5±0.2)cm;②手术切口的安全角度:隐神经髌下支走向为(50.7±4.8)°,隐神经胫骨结节下分支走向(43.3±5.4)°;③提示手术切口的安全范围为距髌韧带在胫骨结节止点的内缘(A点)的内侧(3.5±0.2)cm以内,角度为(50.7±4.8)°。BACKGROUND: More and more attention has been paid to the reconstruction of anterior cruciate ligament by autologous hamstring muscle transplantation, but it was found that some patients had abnormal sensation in the anterior knee and medial anterior leg, which was caused by the injury of the saphenous nerve or the inferior patellar branch of the saphenous nerve when the hamstring tendon was cut intraoperatively. OBJECTIVE: An incision was identified through the anatomy of the knee joint security area and angle, to avoid damaging the saphenous nerve and its infrapatellar branch in harvesting gracilis tendon and semitendinosus tendon. METHODS: Knee joint fresh specimens were harvested from 10 patients who underwent leg amputation. Written informed consent was obtained from each patient. This study was approved by the Ethics Committee of Langdong Hospital Affiliated to Guangxi Medical University and the First Affiliated Hospital of Guangxi Medical University. The saphenous nerve and its branches were isolated. The inner edge of patellar ligament tibial tubercle was marked as point A. A horizontal line through the point A was drawn. The intersection of the horizontal line with saphenous nerve trunk was marked as point C. The intersection of the horizontal line with saphenous nerve infrapatellar branch was marked as point B. The distance between point A and point C and between point A and point B was measured and recorded as distance AC and AB respectively. The scope of operation safety and incision angle would be calculated using analysis and statistic software. RESULTS AND CONCLUSION: Safe range of surgical incision: The distance AC was (5.5±0.3) cm, and the distance AB was (3.5±0.2) cm. Safe angle of surgical incision: The saphenous nerve infrapatellar branch was (50.7±4.8)°, The saphenous nerve tibial tubercle branch was (43.3±5.4)°. The safe range of surgical incision was within the (3.5±0.2) cm in the inner edge of patellar ligament tibial tubercle (A point) and the safe angle was (50.7±4.8)°.

关 键 词：前交叉韧带 自体腘绳肌腱 解剖 隐神经 隐神经髌下支 

分 类 号：R459.9[医药卫生—治疗学] R322[医药卫生—临床医学]