髌韧带与膝交叉韧带的血供及其在交叉韧带损伤重建中的意义

目的　探讨髌韧带和膝交叉韧带的血供特点,为临床韧带重建提供形态学依据。 方法　通过成人和胎儿股动脉红色乳胶灌注并解剖剥离、胎儿墨汁灌注组织透明和组织切片等方法,观察髌韧带和膝交叉韧带的动脉分布特点并测量胎儿韧带内微血管密度。 结果　髌韧带的动脉来自膝下外动脉、胫前返动脉、膝降动脉和膝下内动脉的分支;胎儿髌韧带不同区域微血管密度不同,且以韧带中心部为最低。前、后交叉韧带的动脉分别来源于膝中动脉、髌下脂肪垫以及膝下外动脉的分支。多数韧带内血管沿长轴走行,同时也有横向交通的小血管,血管网呈梯状或平行的丛状。近侧端和远侧端较密而中间部相对稀疏。 结论　①髌韧带和膝交叉韧带均存在中心部乏血管区;②韧带两端血供最丰富,且近侧段好于远侧段;③髌韧带血供优于膝交叉韧带,髌韧带重建交叉韧带具有血供基础。     

髌韧带血供的临床解剖

对 2 0个膝关节的髌韧带血供进行系统研究。在血管内灌注有色天然乳胶后 ,对膝关节伸肌装置的血供进行解剖和组织透明技术的研究。在髌韧带两侧各有上、中、下 3条动脉。中间支起自膝降动脉或膝下内侧动脉。外侧支起自膝外侧动脉或胫动脉返支。 2个主要血管弓通髌后弓和结节上动脉弓与之吻合。吻合弓和动脉蒂均发支形成韧带周围动脉网 ,尤其在髌韧带两极血管密度高。仅吻合弓发出贯穿韧带的侧副动脉 ,构成髌韧带的两极血供模式。髌韧带上部分的血供由髌后弓的深支营养 ,下部分由结节上弓侧副支的浅支营养。这些腱内血管在髌韧带的中 1 / 3相…     

带血管蒂髌骨移位修复膝关节面缺损的应用解剖

目的：为带血管蒂髌骨移位修复股骨髁和胫骨髁关节面缺损提供解剖学基础。方法：用34侧经动脉红色乳胶灌注的下肢标本，经解剖和铸型研究髌骨的血供。观测30块髌骨和胫骨内外侧髁上关节面的形态和面积。结果：供应髌骨的各支动脉先在髌骨周围吻合成髌周动脉环，再由该环发支进入髌骨。参与形成髌周动脉环的主要动脉有膝上外动脉、膝下外动脉、膝降动脉髌上支、膝降动脉髌下支和膝下内动脉。髌骨关节面与股骨内外侧髁关节面、胫骨内外侧髁上关节面形态大小相似。结论：带血管蒂髌骨可以移位至股骨内外侧髁、或胫骨内外侧髁，利用髌骨的关节面修复股骨髁或胫骨髁关节面缺损，以期最大限度保留膝关节的功能。     

髌韧带血供及其在重建膝交叉韧带中的意义

目的：探讨髌韧带血供的特点,为临床交叉韧带移植重建提供应用解剖学资料。方法：通过对成人和胎儿下肢标本经股动脉红色乳胶灌注并解剖观察,以及胎儿墨汁灌注组织透明和组织切片等方法,观察髌韧带的动脉来源、分布特点,并测量胎儿韧带内微血管密度。结果：髌韧带的动脉来自膝下外动脉、胫前返动脉、膝降动脉和膝下内侧动脉的分支;胎儿髌韧带不同区域微血管密度不同,以韧带中心部位密度最低。结论：髌韧带中心部为相对乏血管区,对以髌韧带为替代物行交叉韧带重建有重要的临床意义。     

膝降血管髌下支蒂胫骨骨膜瓣移位修复膝关节面的应用解剖

目的：为用膝降血管髌下支蒂胫骨骨膜瓣移位修复膝关节面病损提供解剖学依据。方法：用30侧经动脉红色乳胶灌注的成人下肢标本,解剖观测膝降动脉髌直支起始、位置、运载胫骨内侧面的分支、分布和吻合。结果：膝降动脉髌下支沿大收肌腱板和收肌结节前面下行,至膝关节间隙水平向前横行于关节囊表面,由此向下发2-5支胫骨骨膜支。这些骨膜支与膝下内侧动脉和稳动脉等动脉的胫骨骨膜支相互吻合,分支分布于胫骨内侧面。结论：以膝降血这髌下支为蒂的胫骨骨膜瓣移位可用于治疗膝关节面病损。     

膝交叉韧带的血供及其临床意义

目的:探讨交叉韧带血管构筑特点、为韧带损伤的重建提供解剖学依据.方法:通过股动脉红色乳胶灌注并解剖观察、墨汁灌注组织透明、组织切片等方法,研究交叉韧带的动脉来源、分布特点并测量韧带内微血管密度.结果:前、后交叉切带的动脉分别来源于膝中动脉、髌下脂肪垫以及膝下外动脉的分支.多数韧带内血管沿长轴走行,同时也有横向交通的小血管,血管网呈梯状或半行的从状.近侧端和远侧端较密而中间部相对稀疏.结论:交叉韧带血供存在如下特点:①中心区为明显的乏血管区;②中间段边缘区也相对乏血管;③韧带两端血供最丰富,且近侧段好于远侧段.     

带血管蒂髌骨移位修复胫骨内侧髁上关节面缺损的解剖与临床

目的：探索用带血管蒂髌骨移位的方法，修复胫骨内侧髁上关节面缺损。方法：用经动脉乳胶灌注的下肢标本37侧，经解剖、厚切片和铸型等方法研究髌骨的血管；观测30块髌骨和胫骨内侧髁上关节面的形态和面积。结果：供应髌骨血液的动脉有多条，这些血管先在髌骨周围相互吻合成髌周动脉环，再由该环发支供应髌骨。于髌骨内下方参与形成髌周动脉环的膝降动脉关节支的髌下支或膝下内动脉干长、位置恒定。髌骨和胫骨内侧髁上关节面的形态和面积相似。结论：带血管蒂髌骨可以移位至腔骨内侧髁，利用髌骨的关节面修复胫骨内侧髁上关节面的缺损，以保留膝关节的功能。     

带血管蒂髌骨移位修复胫骨外侧髁上关节面缺损的应用解剖

目的：研究用带血管蒂髌骨移位的方法修复胫骨外侧髁上关节面缺损。方法：用３７侧成人下肢标本，经解剖、厚切片和铸型研究髌骨的血管。观测３０块髌骨和胫骨外侧髁上关节面的形态和面积。结果：①供应髌骨血液的各支动脉先在髌骨周围吻合成髂周动脉环，再由该环发支进入髌骨；②于髌尖外下方参与形成髌周动脉环的膝下外动脉蒂长、径粗、位置恒定；③髌骨关节面与胫骨外侧髁上关节面形态大小相似。结论：带血管蒂髌骨可移位至胫骨外侧髁，利用其关节面，修复上关节面缺损，以期最大限度地保留膝关节的功能     

带血供半腱肌肌腱转位重建膝交叉韧带的应用解剖

目的：为带血供半腱肌肌腱转位重建膝交叉韧带术提供解剖学基础。方法：在４０侧成人下肢标本上观测半腱肌肌腱形态,血供来源,分支及分布特点：２侧新鲜下肢标本进行模拟术式。结果：半腱肌肌腱长１５．１ｃｍ、宽０．５ｃｍ、、厚０．４ｃｍ,ａ其血供来源于动半腱肌支,膝下内侧动的腱支、腱外周组织血管网动脉和胫前返动脉。结论：半腱肌肌腱与交叉韧带形态相似,有足够的游离长度。血供丰富,为多源性。以半腱肌肌腱转移重起初     

新型开放式膝横型径路治疗半月板损伤的解剖学研究

目的为膝横型径路治疗半月板损伤提供必要的人体结构基本数据。方法 50膝成人下肢标本,取膝屈曲90°~100°,模拟膝横型手术径路,解剖观测横型径路切口及相关主要结构。结果内侧横型径路切口长(55.64±9.82)mm,外侧横型径路切口长(54.82±8.42)mm;隐神经髌下支是内侧模型径路术中易损伤结构,其跨越内侧横型径路处呈宽扁形,宽(1.24±0.38)mm,厚(0.44±0.58)mm,距髌韧带内侧缘(38.42±1.24)mm;膝上、下内侧动脉,膝上、下外侧动脉及胫前返动脉是主要相关血管,穿出深筋膜后在径路上、下方吻合成膝周血管网。结论横型径路切口小,远离较大重要血管,解剖层次结构简单,单一横型径路即可充分显露半月板;术中有效视野广,操作安全有效。     

Clinical anatomy of the arterial supply of the human patellar ligament

The arterial supply of the human patellar ligament has been systematized on 20 knee joints. After intravascular injection of colored natural latex, the blood supply to the extensor apparatus of the knee was studied by anatomical dissection and tissue transparentation techniques. Three arterial pedicles (superior, middle and inferior) were observed placed on each side of the patellar ligament. Medial pedicles had their origin from the descending and the inferior medial genicular arteries. The lateral pedicles took their origin from the lateral genicular arteries and the recurrent tibial anterior artery. Two main vascular arches anastomosed with these pedicles: the retropatellar and the supratubercular. Both arterial pedicles and anastomotic arches gave rise to a peritendinous network, characterized by a high vascular density next to poles of the patellar ligament. Only the anastomotic arches gave rise to collateral vessels that pierced the tendon, which revealed two vascular segments in the arterial supply of the patellar ligament (bipolar pattern). The upper segment was supplied by deep vessels from the retropatellar arch, whereas the inferior segment received superficial vessels from collaterals of the supratubercular arch. These intratendinous vessels anastomosed in the middle third of the patellar ligament.     

带血供大收肌腱转位修复膝关节韧带的应用解剖及临床 …

目的：报道以膝上内侧血管为蒂大收肌腱转位重建膝关节韧带断裂缺损的应用解剖及术式设计。方法：４０侧经动脉灌注红色乳胶成人标本,解剖观测大收肌腱的形态及其血供,２侧新鲜下肢标本模拟手术设计。以膝上内侧血管为蒂大收肌腱转位修复膝关节韧带断裂缺损。结果：应用带血供大收肌腱转位修复胫侧副韧带３０例,胫侧副韧带和前交叉韧带８例,胫侧副韧带和后交叉韧带４例,多韧带损伤１例,经随访疗效为满意。结论：大收肌腱与膝关     

An inconstant ligament in the popliteal region associated to the superior genicular arteries: surgical importance

Materials and methods In the dissection of 60 knees of 30 cadavers (13 women and 17 men), a ligament was located in the posterior femur face above the lateral or medial condyle.Results This ligamentous structure was found in 12 (20%) out of 60 knees studied (38% of the women and 35% of the men). It had a vertical arrangement and a constant direct relation to the superior (lateral or medial) genicular artery, and in no case it appeared as a posterior reinforcement of the capsule. The superior vessels were fixed by this ligament.Discussion This fixation may provide stability to the vascular tree but it could be a cause of post-surgical hemarthrosis in arthroscopy of the posterior knee area or in posterior or lateral knee approaches or it could be even implicated in vascular injury of the popliteal artery during knee dislocation.Conclusion The objective was to describe this inconstant ligament and to study its clinical relevance for surgical procedures, and particularly for those using the posterior approach to the knee joint.     

Arterial supply to the human anterior cruciate ligament

The arterial supply to the anterior cruciate ligament (ACL) was prepared for study by injecting a fresh cadaver knee with an epoxy lead-oxide solution and subsequently immersing it in 10% formalin for a 2-week period. The vasculature of the ACL was exposed through dissection for examination. A second specimen was prepared similarly and was evaluated by a CAT scan. ACL vascularization arises from the middle genicular artery and vessels of the infrapatella fat pad and adjacent synovium. The artery gives rise to periligamentous vessels which form a web-like network within the synovial membrane. These periligamentous vessels give rise to penetrating branches which transversely cross the ACL and anastomose with a network of longitudinally oriented endoligamentous vessels. Terminal branches of the inferior medial and lateral genicular arteries supply the distal portion of the ACL directly. The extremities of the ACL seem to be better vascularized than the middle part, and the proximal portion seems to have a greater vascular density than the distal portion. The arteries at the ligamentous-osseous junctions of the ACL do not significantly contribute to the ligament's vascularity. Ramifications concerning the ACL's blood supply as it relates to athletic training is also discussed.     

Vascular anatomy of the patella: Implications for total knee arthroplasty surgical approaches

BackgroundIatrogenic disruption of the patellar vascular supply has been identified as a possible contributing factor to the commonly reported patellofemoral complications following total knee arthroplasty (TKA). We performed an anatomic cadaveric study evaluating the extra-osseous vascular anatomy of the patella, and correlated our findings to routine TKA surgical dissection to determine how to better preserve patellar vascularity.Methods and materialsIn twenty-one cadaveric knees arterial cannulas were placed proximally and distally to the patella. A polyurethane compound was then injected producing a visible arterial network. Specimens underwent gross dissection.ResultsIn all 21 specimens, the supreme genicular (SGA), medial/lateral superior genicular (MSGA/LSGA), medial/lateral inferior genicular and anterior tibial recurrent arteries communicate forming a peripatellar anastomotic ring supplying the intraosseous patellar system. Both the SGA (24%) and MSGA (76%) demonstrated dual medial ring contribution. Relating the arterial location to common TKA exposures suggested severe compromise of patellar vascularity.ConclusionThe medial sided vessels seem to contribute more significantly to the peripatellar anastomotic ring when compared to the lateral sided vessels. Careful soft tissue management has the potential to preserve key vascular structures that could maintain the intraosseous vascular supply to the patella. Understanding the anatomic locations of major arterial systems around the knee joint can potentially help during hemostasis, and can minimize blood loss during TKA.Clinical relevanceRecognition of major arterial systems around the knee joint has the potential to minimize iatrogenic disruption of the vascular supply and the complications that can follow (patella devascularization and blood lost).     

The arterial supply of the patellar tendon: Anatomical study with clinical implications for knee surgery

The middle‐third of the patellar tendon (PT) is well‐established as a potential graft for cruciate ligament reconstruction, but there is little anatomical basis for its use. Although studies on PT vascular anatomy have focused on the risk to tendon pedicles from surgical approaches and knee pathophysiology, the significance of its blood supply to grafting has not been adequately explored previously. This investigation explores both the intrinsic and extrinsic arterial anatomy of the PT, as relevant to the PT graft. Ten fresh cadaveric lower limbs underwent angiographic injection of the common femoral artery with radio‐opaque lead oxide. Each tendon was carefully dissected, underwent plain radiography and subsequently schematically reconstructed. The PT demonstrated a well‐developed and consistent vascularity from three main sources: antero‐proximally, mainly by the inferior‐lateral genicular artery; antero‐distally via a choke‐anastomotic arch between the anterior tibial recurrent and inferior medial genicular arteries; and posteriorly via the retro‐patellar anastomotic arch in Hoffa's fat pad. Two patterns of pedicles formed this arch: inferior‐lateral and descending genicular arteries (Type‐I); superior‐lateral, inferior‐lateral, and superior‐medial genicular arteries (Type‐II). Both types supplied the posterior PT, with the majority of vessels descending to its middle‐third. The middle‐third PT has a richer intrinsic vascularity, which may enhance its ingrowth as a graft, and supports its conventional use in cruciate ligament reconstruction. The pedicles supplying the PT are endangered during procedures where Hoffa's fat pad is removed including certain techniques of PT harvest and total knee arthroplasty. Clin. Anat. 22:371–376, 2009. © 2009 Wiley‐Liss, Inc.     

Spontaneous recurrent haemarthrosis following unicompartmental knee arthroplasty and its successful treatment by coil embolisation

A case of spontaneous recurrent haemarthrosis of the knee presenting 3 months after the unicondylar knee replacement is described. Femoral arteriography demonstrated hypertrophy of the saphenous branch of descending genicular artery with a prominent vascular blush in the region of posteromedial aspect of the popliteal fossa thought to represent a hypertrophic vascular mass of synovium. Therapeutic embolisation of the saphenous branch of descending genicular artery was performed using three fibred platinum coils with satisfactory clinical results. Since the embolisation, the haemarthrosis has not recurred. To our knowledge, this therapeutic procedure used to treat recurrent haemarthrosis following unicondylar knee arthroplasty has not been previously described in the literature.     

静脉蒂股骨外侧髁骨膜瓣修复膝关节软骨缺损的应用解剖

目的　为修复膝关节软骨缺损提供一个新的骨膜瓣供区。方法　在 5 0侧成人下肢标本上 ,解剖观察了膝上外侧血管的起始、行径、分支、分布及与周围血管的吻合 ;对另 3例进行了摹拟手术及静脉逆行灌注。结果　膝上外侧血管在股骨外侧髁上方 (2 5± 0 5 )cm处起自于血管 ,分出升支、横支、降支及浅支。横支、降支分布于股骨外侧髁。横支与膝降血管吻合 ,吻合率为 10 0 % (5 0侧 ) ;浅支与髌周血管环吻合 ,吻合率为 10 0 % (5 0侧 ) ;升支与旋股外侧血管降支吻合 ,吻合率为 92 %(4 6侧 )。上述血管束及分支均包含一条动脉、二条静脉。结论　在股骨外侧髁可以切取以膝上外侧血管横支、浅支或升支静脉为蒂的骨膜瓣 ,转移修复膝关节软骨缺损