Preliminary note on biometric data relating to the human coraco-acromial arch

A biometric study based on 20 human scapulae made it possible to specify the variations in the gap of the coraco-acromial arch in relation to its depth and height. A graphic representation in rectangular coordinates, then in spatial representation in relation to the three planes of reference, leads to the following findings: the bony variations in the arch occur essentially: at the coracoid apophysis, and two types of arch can be distinguished depending on the predominance of bony or of ligamentous components.     

Anatomy and magnetic resonance imaging of the posterolateral structures of the knee

The purpose of the present study was to provide detailed information of the morphological and radiological characteristics of the posterolateral structures of the knee. Muscles and ligaments of the posterolateral part of the knee were studied by dissections of 50 adult cadaver knees and by Magnetic Resonance Imaging (MRI) before and after dissections for comparisons. Diverse morphological characteristics of the arcuate ligament were found. The fabellofibular ligament was present in 42.1% of the knees dissected, whereas the popliteofibular ligament was found in 37.5%. A ligamentous structure, which could be called the posterior tibial ligament, was found in 31.6% of the cases that originated from the lateral part of the capsule proximally and inserted distally on the mid portion of the proximal tibia. By comparing the cross sections and the dissections of the cadaver knees, the popliteus muscle, the arcuate ligament, the fibular collateral ligament, the popliteofibular ligament, and the fabellofibular ligament could be identified in MRI. Comprehensive understanding of the posterolateral anatomy of the knee and improved identification of the structures in MRI will help clinicians to make a more accurate and noninvasive diagnosis of posterolateral instability. Clin. Anat. 10:397–404, 1997. © 1997 Wiley-Liss, Inc.     

Development of the human knee joint ligaments

ABSTRACT Background: Many studies have been published on the development of the human knee joint, but scant attention has been given to the development of the knee joint ligaments. The only elements that have received much attention are the cruciate ligaments and their relationships with the synovial membrane. Methods: We summarize our observations on the development of the knee joint ligaments in 50 serially sectioned human embryonic and fetal lower limbs (26 embryos and 24 fetuses). Results: The patellar ligament begins to form in O'Rahilly stage 20, with the muscle fibers of the quadriceps muscle being attached inferiorly to the tibial tuberosity. The cruciate ligaments (beginning with the posterior) arise from the articular interzone in O'Rahilly stage 21. Subsequently, with the organization of the Wrisberg's meniscofemoral ligament, in week 10 of development, the cruciate ligament system is completed. The lateral collateral ligament begins to form in O'Rahilly stage 23, and from its first appearance it is independent of the knee joint capsule. At this time, development of the tendon of the popliteus muscle begins. The medial collateral ligament begins to develop in week 9 of development as a condensation of the joint capsule. Two weeks later, the intra-articular pad of fat begins to form from mesenchymal tissue below the patella and between the cruciate and the patellar ligaments. With the organization of the suprapatellar bursa in week 14 of development, knee joint development is complete. Conclusions: The morphogenetic time table of the knee joint ligaments was established. Anat. Rec. 248:259-268, 1997. © 1997 Wiley-Liss, Inc.     

人工韧带生物材料修复膝关节交叉韧带损伤：问题及前景

BACKGROUND: Related studies have confirmed that the experimental results and short-term clinical outcomes of artificial ligaments are satisfactory that the artificial ligaments can restore the stability of knee joint as soon as possible and ensure motor function. OBJECTIVE: To summarize the basic and clinical research progress of artificial ligaments. METHODS: The articles regarding artificial ligaments in repair of knee joint cruciate ligament injury were retrieved from Wanfang database, CNKI and PubMed database during 1985 to 2015 by computer. The keywords were “cruciate ligament injuries, artificial ligament, biological materials” in Chinese and English, respectively. RESULTS AND CONCLUSION: Compared with autologous and allogenic ligaments, artificial ligament has good mechanical properties, and can get sufficient tensile strength and joint stability immediately after implantation, so as to ensure the cruciate ligament reconstruction of the knee joint. Artificial ligament technology has experienced carbon fiber ligament, polyester material and stent artificial ligaments. As a new type of polyester artificial ligament, LARS artificial ligament shows a good biocompatibility, on which, cells can adhere, proliferate and differentiate well. However, the controversies over the use of artificial ligament still exist, and its long-term clinical effects still need further observation. Further researches regarding the material selection, shape bionic design, weaving and surgical techniques of artificial ligaments are still further needed.      

组织工程化前交叉韧带在运动损伤修复中应用

背景：运动员前交叉韧带的损伤极难彻底恢复,降低运动寿命。 目的：总结组织工程化前交叉韧带在运动损伤修复中的研究现状和最新进展。 方法：采用计算机检索维普数据库和PubMed数据库1994-01/2010-12相关文章,纳入28篇与运动性前交叉韧带损伤及组织工程韧带相关的文章,重点对组织工程前交叉韧带重建的研究进展、前交叉韧带种子细胞的来源、细胞因子在前交叉韧带重建中的应用及组织工程前交叉韧带附丽的基础研究4个方面进行探讨。 结果与结论：运动中前交叉韧带损伤后自体愈合能力极差,对于运动员伤后痊愈造成极大困难。组织工程前交叉韧带近些年来飞速发展,具有良好的应用和发展前景。但在实际应用过程中,组织工程化种子细胞的选择、支架材料的构建和组织工程前交叉韧带附丽的基础研究三者有机相互融合,并合理应用生长因子,才能在临床上起到最佳治疗效果,最终达到修复和重建前交叉韧带的目的。     

复合骨髓间充质干细胞的生物型异种韧带移植修复损伤前交叉韧带

背景：异种韧带易于获得,具有韧带支架结构,有利于组织长入和爬行替代,经处理可完全消除抗原性,不引起免疫排斥反应,具有良好生长支架功能 。 目的：探索生物型异种韧带替代同种异体韧带移植重建山羊前交叉韧带损伤的可行性。 方法：将24只健康山羊随机等分成A,B,C三组,取羊的左膝关节,制作成前交叉韧带断裂缺失模型,建立胫骨、股骨端骨隧道后,A,B,C组分别植入复合骨髓间充质干细胞的生物型异种韧带、生物型异种韧带和同种异体韧带。 结果与结论：复合骨髓间充质干细胞的生物型异种韧带植入山羊体内后,无明显排斥反应,具有良好的组织相容性,植入韧带作为功能性支架重建前交叉韧带,在动物膝关节内环境的诱导下,使自体新生组织长入并替代支架,形成自体新生韧带,骨腱部愈合良好,但其与同种异体韧带重建前交叉韧带在组织学、免疫反应、生物力学方面差异无显著性意义,而植入复合骨髓间充质干细胞的生物型异种韧带山羊宿主自体组织可以长入并建立微循环。提示复合骨髓间充质干细胞的生物型异种韧带可加速微循环建立,促进韧带生长,尤其对韧带再血管化作用显著,但对韧带生物力学无明显影响。中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

Histopathological features of failed prosthetic Leeds-Keio anterior cruciate ligaments.

Artificial ligaments such as the Leeds-Keio ligament are inserted into knee joints to treat cruciate ligament trauma. Three cases of prosthetic ligament failure are reported, showing foreign body granulomatous inflammation around implanted fibres, together with abundant fibre particles within giant cells. It is suggested that intra-operative fibre fragmentation can produce a sufficient quantity of dendritic particles to elicit a granulomatous reaction, which can ultimately lead to ligament instability and failure.     

Resource implications of a knee referral

Introduction: The latest government targets state that by the end of 2005 the maximum waiting time for an outpatient appointment will be 3 months. These recommendations will not only increase the size of the outpatient clinics, but also the resources required thereafter. The purpose of this study was to analyse the outcome of new patient referrals to one knee outpatient service in order to quantify the resources required to investigate and treat these patients. Method: All new patients attending one consultant's knee outpatient service in the time period January 1st 1997 to December 31st 1997 were prospectively entered into a database recording patient details, source of referral and diagnosis. Eighteen months after the time period a cohort of 200 patients was randomly selected and the case notes were analysed. The number of outpatient appointment episodes, MRI scans, physiotherapy referrals and surgical episodes generated were recorded for each patient. Results: Analysis of the initial database records show that a total of 662 new knee referrals were seen in 1997. Fifty-two percent (341) were made up of the five most common diagnoses, these being osteoarthritis, anterior knee pain, anterior cruciate ligament injury, medial ligament injury and medial meniscus injury. Retrospective analysis of the 200 patient notes revealed that these patients required a total of 499 outpatient episodes, 43 MRI scans, 180 courses of physiotherapy and 93 surgical episodes (53 elective and 40 emergency). These figures can be used to predict the resources that would be required by all new patients seen in an outpatient knee service in a year. Discussion: Each new patient that enters the cycle of investigation followed by treatment must be met by extra resources. If this does not occur the net result will be that although government targets may be met, the time taken to complete each patient episode will become longer. It is imperative that before an agreement is made to see new patients the resources required to manage them are in place.     

弹簧韧带的解剖观测和MRI分析研究

目的　通过解剖学研究了解弹簧韧带的解剖特点并探讨其功能作用,同时应用MR观察弹簧韧带,分析其在MRI上的显示情况。  方法　解剖并观察弹簧韧带,了解其起止、走形及形态特征等情况,测量相关数据。同时对弹簧韧带不同扫描平面的MRI进行分析研究。  结果　弹簧韧带起于跟骨的载距突,由上内跟舟韧带,内下斜行跟舟韧带和下跟舟韧带3部分组成,分别止于舟骨的上内侧面,舟骨粗隆下和舟骨喙突。MR可以清楚的显示弹簧韧带的各部分结构,在T1及T2加权图像上呈中低信号表现,以矢状面和横断面显示较佳。  结论　弹簧韧带是足底部承载距骨头的一重要韧带复合体结构,对足纵弓的维持具有重要意义,MR可作为弹簧韧带损伤时的诊断工具。     

人工韧带修复膝关节交叉韧带损伤

背景：以往治疗膝关节交叉韧带损伤的主要手段是移植重建,最常用的移植材料为自体的骨髌腱骨、半腱肌腱和股薄肌腱。但由于此类移植物存在取材区并发症及韧带化过程中的各种问题,近年来人工韧带的研究受到重视。 目的：认识膝关节交叉韧带的结构及血供特点,以及膝关节交叉韧带损伤后人工韧带重建治疗机制与临床应用特点。 方法：①分析膝关节前、后交叉韧带的组织结构,功能学特点以及血供差异。②分析膝关节前、后交叉韧带损伤的类型及生物力学机制。③分析修复膝关节交叉韧带损伤的材料学分类及特点。④分析人工韧带修复后影响关节稳定性的因素。 结果与结论：修复膝关节前、后交叉韧带损伤时,应首先考虑到前、后交叉韧带的功能及血供情况,选择合适的重建物,使重建时过程简化,操作简单,重建材料的组织相容性较好,达到修复后的解剖与功能的双重建。     

腘腓韧带的形态学研究及生物力学分析

膝关节后外侧区有着复杂的解剖结构,后外侧区的损伤可导致膝关节后外侧旋转不稳定。本文综述了膝关节后外侧区结构之一的腘腓韧带的形成机制、形态学和生物力学研究进展及存在的问题。     

碱性成纤维细胞生长因子基因转染骨髓干细胞与韧带成纤维细胞共培养效应

背景：碱性成纤维细胞生长因子在韧带损伤愈合中具有重要作用,细胞因子转染的骨髓间充质干细胞可作为种子细胞应用于韧带组织工程。目的：探讨人碱性成纤维细胞生长因子基因修饰的骨髓间充质干细胞与韧带成纤维细胞三维共培养后的交互生物学效应。方法：原代培养大鼠骨髓间充质干细胞,传至第3代后分为3组：对照组、Ad-EGFP组及Ad-bFGF组。各组细胞相应处理后分别与韧带成纤维细胞三维共培养,MTS法检测细胞增殖能力,ELISA法检测各组细胞上清液中碱性成纤维细胞生长因子蛋白水平,RT-PCR检测各组两种细胞中Scleraxis、Ⅰ型胶原、Ⅲ型胶原、核心蛋白多糖、软骨低聚物基质蛋白等相关基因mRNA表达量的变化。结果与结论：腺病毒介导的碱性成纤维细胞生长因子可高效转染骨髓间充质干细胞;共培养3,6 d后,与对照组及Ad-EGFP组相比,Ad-bFGF组两种细胞增殖活性增强(P < 0.01);上清液中碱性成纤维细胞生长因子表达明显增高(P < 0.01),韧带成纤维细胞中Ⅰ型胶原、Ⅲ型胶原、核心蛋白多糖、软骨低聚物基质蛋白mRNA表达均降低(P < 0.01),骨髓间充质干细胞中Scleraxis、Ⅰ型胶原、Ⅲ型胶原mRNA表达均明显升高(P < 0.01)。以上结果表明碱性成纤维细胞生长因子转染的骨髓间充质干细胞与韧带成纤维细胞三维共培养促进韧带成纤维细胞增殖的同时抑制了其胶原合成能力,促进骨髓间充质干细胞增殖的同时增强了其向韧带成纤维细胞分化的能力。  中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

锁骨沟板联合喙肩韧带重建喙锁韧带治疗陈旧性肩锁关节脱位

目的 评价应用锁骨钩板联合喙肩韧带重建喙锁韧带治疗陈旧性肩锁关节脱位的临床疗效。方 法 20例陈旧性性肩锁关节脱位的病人采用锁骨钩板联合喙肩韧带重建喙锁韧带治疗。全部病人获得随 访,随访6～24月。结果 按Karlsson标准进行评价:优良16例,满意4例。患者无感染,无金属内 固定物折断及松动,肩锁关节无再脱位或半脱位。结论 应用锁骨钩板联合喙肩韧带重建喙锁韧带治疗 陈旧性肩锁关节脱位,固定可靠,可以早期功能锻炼,疗效满意。     

带血管蒂肝圆韧带瓣转位修复胆管缺损的应用解剖

观察30例成人肝圆韧带标本,肝圆韧带呈纤维条索样,内含少许不规则残腔。肝圆韧带的血液供养主要来自肝右动脉的分支及伴行的附脐静脉。由于肝圆韧带近端紧邻胆管,远端易于游离,提出了带血管蒂的肝圆韧带瓣作为自体生物材料来修复肝外胆管的缺损,并讨论了该术式有关的应用解剖要点。     

Tubular Woven Narrow Fabrics for Replacement of Cruciate Ligaments

The human knee is one of the most frequently injured joints. More than half of these injuries are related to a failure of the anterior cruciate ligament. Current treatments (allogeneic and autologous) bear several disadvantages which can be overcome through the use of synthetic structures. Within the scope of this paper the potential of tubular woven fabrics for the use as artificial ligaments has been evaluated. Twelve fabrics made of polyethylene terephthalate and polytetrafluoroethylene were produced using shuttle weaving technology. Mechanical and biological properties of the fabrics were assessed using static tensile testing and cytotoxicity assays. The results obtained within this study show that woven tubular fabrics can be potentially used as artificial ligament structures as they can provide the desired medical and mechanical properties for cruciate ligament replacements. Through the choice of material and weaving parameters the fabrics’ tensile properties can imitate the stress–strain characteristic of the human cruciate ligament. Further assessments in terms of cyclic loading behavior and abrasion resistance of the material are needed to evaluate the success in long term implantation.     

牙周膜干细胞的研究进展

背景：从牙周膜组织中分离出的牙周膜干细胞被认为是牙周组织工程的首选种子细胞,有自我更新能力,能分化形成牙周的3种组织：牙槽骨、牙周膜和牙骨质。 目的：就近年来牙周膜干细胞的分离、鉴定、相关细胞因子等方面进行简要综述。 方法：由第一作者检索Pubmed 数据库(http://www.ncbi.nlm.nih.gov/pubmed)、中国知网数据库(http://www. cnki.net/)2004-01/2010-09有关牙周膜干细胞分离、鉴定、相关细胞因子等方面的文献,英文检索词为“periodontal ligament stem cell”,中文检索词为“牙周膜,干细胞”。排除重复性研究,最终纳入35篇文献进行综述。 结果与结论：牙周膜干细胞是一种很有潜力的牙周组织工程种子细胞,能构建组织工程牙周膜,促进牙周缺损的修复。随着研究的深入,影响牙周膜干细胞生物性能的因素逐渐被发现,但其研究还有待进一步完善。     

非接触性前交叉韧带损伤的生物力学风险评估及预防

背景：非接触性前交叉韧带损伤占前交叉韧带损伤的80%,且多发生于青春期女性,如何对损伤的风险因素进行评估,用于高危人群的筛选,对有效预防损伤至关重要。 目的：对非接触性前交叉韧带损伤的生物力学风险因素和预防手段进行阐述,为非接触性前交叉韧带损伤的预防开辟新的思路。 方法：应用计算机在互联网检索PubMed数据库和CNKI数据库1979至2014年相关文献,在英文标题和摘要中以“on-contact anterior cruciate ligament, biomechanicas,risk factors”和“non-contact anterior cruciate ligament,prevention”等关键词搜索,中文文献以“前交叉韧带损伤,生物力学”为关键词,选择内容与非接触性前交叉韧带损伤生物力学分析和预防有关的文献。共纳入文献58篇。 结果与结论：应用生物力学评估的手段对参加运动项目的青少年人群进行筛查,对落地、急停、切步等高危动作中膝关节的运动学进行分析,发现非接触性前交叉韧带损伤的高风险人群。尽早预防性训练计划的干预可以提高运动表现、纵跳高度及膝关节动态负荷状态下的稳定性,发展平衡和提高腘绳肌的力量及核心控制能力,可以最大限度预防非接触性前交叉韧带损伤的发生。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：