膝关节周围孔道结构与肿瘤复发的相关性  

The relationship between the recurrence rate of aggressive tumors and the foramina around the knee joint

作　　者：程坤 杨强[2] 李秋尧 高晓斐 冯琨 刘涛 姜慧峰 邵显昊 吴玉仙 李建民[2] 李玉椿 Cheng Kun;Yang Qiang;Li Qiuyao;Gao Xiaofei;Feng Kun;Liu Tao;Jiang Huifeng;Shao Xianhao;Wu Yuxian;Li Jianmin;Li Yuchun(Department of Bone Tumor,Qilu Hospital of Shandong University,Qingdao 266035,China;Department of bone tumor,Qilu Hospital of Shandong University,Ji'nan 250012,China;Department of Pathology,Qilu Hospital of Shandong University,Qingdao 266035,China;Department of Imaging,Qilu Hospital of Shandong University,Qingdao 266035,China)

机构地区：[1]山东大学齐鲁医院(青岛)骨肿瘤科,266035 [2]山东大学齐鲁医院骨肿瘤科,济南250012 [3]山东大学齐鲁医院(青岛)病理科,266035 [4]山东大学齐鲁医院(青岛)影像科,266035

出　　处：《中华骨科杂志》2020年第6期325-334,共10页Chinese Journal of Orthopaedics

基　　金：山东大学齐鲁医院(青岛)科研院长基金(QDKY2019YZ01)。

摘　　要：目的介绍"股骨髁间孔"、"胫骨髁间隆突孔"的发现及命名,并探讨膝关节周围侵袭性肿瘤术后高复发率与膝关节周围孔道结构的关系。方法影像学观察、测量:收集我院影像中心数据库200例患者的CT扫描三维重建资料,观察"股骨髁间孔"、"胫骨髁间隆突孔"、"股骨髌股关节面上孔"的普遍性,并进行影像学定位、测量。解剖及组织学观察:通过15例车祸或肿瘤截肢新鲜标本及60例尸体解剖,实物证明其存在,并对"股骨髁间孔"、"胫骨髁间隆突孔"具体位置、孔道周围结构、孔道近端覆盖情况、孔道内容物、孔口、孔壁及孔底组织进行研究分析。切取瘤段解剖、组织及病理学观察:通过对股骨远端及胫骨恶性肿瘤切取瘤段的研究,包括原发以及骨转移瘤通过此通路向骨内传播转移,通过解剖与组织学以及影像学分析,观察孔道结构与肿瘤的关系;判断肿瘤通过孔道隐匿及双向传播情况;肿瘤复发与孔道结构的相关性分析。病变孔口滑膜分析,尤其影像疑似滑膜受累及的病例,观察滑膜是否肿瘤浸润。结果"股骨髁间孔"、"胫骨髁间隆突孔"是人体固有的生理存在,200例均观察到该结构,其生理功能为膝中动脉分支进入股骨髁间窝及胫骨髁间隆突(孔)的血管孔;股骨髁间孔"、"胫骨髁间隆突孔"孔口与关节腔之间由滑膜组织间隔,并且其由滑膜组织、半月板及交叉韧带与关节腔形成立体间隔。膝关节侵袭性肿瘤侵犯到孔道结构后,并非即刻突入关节腔,而在孔道中隐匿,以其特定的生物学行为对滑膜进行侵犯,滑膜病变顺序:反应性水肿、增厚,退变、钙化、玻璃样变(部分病例观察到浸润),滑膜破裂,肿瘤侵犯关节腔。往往在滑膜破裂之前,临床上已观察到肿瘤或观察到肿瘤复发。肿瘤有沿膝中动脉传播至腘血管及周围软组织、淋巴管的趋势,影像表现为腘血管周围淋巴结肿大。色�Objective To introduce the discovery and nomenclature of the intercondylar foramen of femur(IFF)and foramen of tibial intercondylar eminence(FTIE)and research the close relationship between the high recurrence rate of aggressive tumors around the knee joint and the foramina around the knee joint.Methods①Radiographic observation and measurement:3D reconstruction of CT scan of 200 patients in our hospital were used to obverse the common feature、position and measure of Inter-condylar foramen of femur and Foramen of tibial intercondylar eminence.②Anatomical and histological observation:To proof the existence of IFF and FTIE through the anatomy of 15 cases of car accidents or tumor amputations and 60 cases of autopsy.Then the specific location,the surrounding structure,the proximal coverage,the contents,the apical construction,the wall and the bottom tissues of the IFF and FTIE were studied and analyzed.③Histological and pathological observation of tumor anatomy:Through the study of the distal femur and tibia malignant tumor tissues(including primary bone tumors and metastatic tumors),we observed the relationship between the foraminal structures and the tumor,judged the situation of concealed transmission and two-way spread through the foramina,and analyzed the relationship between tumor recurrence and foraminal structures.④The synovial membrane of foramina,especially in cases where the synovium was suspected to be involved by the lesions judged by the radiography was analyzed to observe whether the synovium was infiltrated by the tumor.Results IFF and FTIE were the inherent physical structure of the human.Their physiological function was the vascular foramina that lead the branches of arteria media genus into the Intercondylar fossa of femur and tibial intercondylar eminence.Their opening was separated with the joint cavity by the synovial tissues,so IFF and FTIE were isolated with joint cavity by the synovial tissues、meniscus and cruciate ligaments.After invading the IFF and FTIE,the aggressive tumors di

关 键 词：股骨 胫骨 解剖学 骨肿瘤 

分 类 号：R730[医药卫生—肿瘤] R6[医药卫生—临床医学]