成人膝关节前外侧韧带的应用解剖学研究

目的 探究国人膝关节前外侧韧带(ALL)的解剖学特点,为临床膝关节ALL损伤的诊治及手术修复重建提供解剖学依据。方法 由山西医科大学解剖教研室提供的成人膝关节标本19具(膝周组织完好无破损、无畸形及手术外伤史),其中左膝关节9具、右膝关节10具。以膝前外侧为中心逐层解剖至关节囊层,寻找并观察ALL的起止点及走行等解剖学特点,测量并记录ALL的解剖数据,对ALL及其毗邻结构拍照记录,进行定性及定量描述。结果 19具膝关节标本中,17具发现ALL。ALL在中立0°位和屈曲60°并内旋5°位时的长度分别为(34.72±6.35)mm和(39.53±6.80)mm,在股骨侧止点、胫骨侧止点的宽度分别为(7.75±0.71)mm、(9.41±1.19)mm,在关节线处宽度为(6.79±1.01)mm。ALL整体是以宽扁样形态由后上向前下走行于膝关节前外侧缘,在关节线处的厚度为(1.21±0.20)mm;ALL在胫骨处以宽大的扇形结构止于外侧胫骨平台Gerdy结节与腓骨头连线中点偏上、距胫骨软骨缘的垂直距离为(11.62±1.32) mm,其胫骨侧止点距Gerdy结节的距离为(19.95±4.63) mm、距腓骨头的距离为(19.47±3.65) mm,Gerdy结节至腓骨头的距离是(33.82±4.69) mm。结论 ALL是一条位于膝关节前外侧关节囊外的独立非等长韧带结构,起于股骨外上髁的后上方,向前下走行,与外侧半月板体部相连,止于外侧胫骨平台前外部,对维持膝关节旋转稳定性发挥着一定的作用。     

前交叉韧带重建国际研究现状及趋势的可视化分析

背景:前交叉韧带损伤是膝关节最常见的损伤之一,对前交叉韧带重建相关研究进行文献计量学及可视化分析,可以帮助理清这一领域的研究历程,快速了解现有研究热点,合理预估未来的研究趋势,能够推动该领域的进一步发展.目的:分析前交叉韧带重建的全球研究现状及热点、未来发展趋势.方法:选用Web of Science科学引文索引的扩展...     

基于文献计量学与可视化分析的骨组织工程支架材料的全球研究现状及发展趋势

目的通过对骨组织工程支架材料的相关文献进行阅读和归纳总结，对相关文献进行文献计量学和相关热点可视化分析，比较不同年份、基金资助机构、机构、作者、来源出版物、国家、文献被引和关键词的相关数据为将来骨组织工程支架材料的研究提供参考。 方法以骨组织工程和支架材料为主题在Web of Science数据库中检索2009年1月1日到2021年12月31日的相关文献，应用文献计量学方法，使用Excel软件对检索到的相关数据进行归纳总结并绘图，利用VOS-viewer软件将文献数据进行可视化分析，并对研究热点进行解读，分析组织工程支架材料的研究现状及发展方向。 结果筛选后共纳入了2 145篇文献，根据文献计量学分析发现骨组织工程支架材料的发文量在逐年上升，其中2020年发文量最高(261篇)，占总发文量12.168%。预测2022年发文量为299篇；从发文量方面看National Natural Science Foundation Of China Nsfc是发文量最多的基金资助机构，有378篇；LEAGUE OF EUROPEAN RESEARCH UNIVERSITIES LERU是发文量最多的机构，共发文80篇；Boccaccini AR是发文量最高的作者，被引总频率1 905；MATERIALS SCIENCE ENGINEERING C MATERIALS FOR BIOLOGICAL APPLICATIONS是发表最多的出版物，共110篇占5.128%；中国是发文量最多的国家，多达608篇占28.345%；被引频率最高的文献是Susmita Bose发表在Trends in Biotechnology的一篇文章。通过文献耦合分析发现关联强度最高的机构和国家分别是中国科学院和美国；并且关键词耦合可视化分析发现骨组织工程支架材料的研究分为"支架材料类型""支架材料需要具备的特征及制备""支架材料的修复过程"三方面，分时段比较分析显示其中"3D打印""力学性能""水凝胶""丝素蛋白"等将成为未来的研究趋势及热点。但是研究最多的是羟基磷灰石、生物材料、体外、力学性能等。 结论近年来关于骨组织工程支架材料的研究日益增多，虽然"3D打印""力学性能""水凝胶""丝素蛋白"逐渐成为研究热点，但是相关研究仍然较少，此外支架材料种类也越来越多。但是仍有许多不足，未来需要各个机构和国家相互交流，以便研究出更适合人体的支架材料。     

膝关节前外侧韧带的研究进展

目的 总结膝关节前外侧韧带的研究进展。方法 在中国知网、万方数据、中国生物医学文献数据库和PubMed数据库,分别以“膝关节”“前外侧韧带”“前外侧关节囊”“Segond骨折”为关键词,检索1980年1月—2015年10月与膝关节前外侧韧带的解剖学、组织学、生物力学及其损伤的临床诊断和外科治疗有关的文献进行分析总结。结果 前外侧韧带近端起源于股骨外侧髁腘肌腱止点附近,远端止于Gerdy结节外侧,经组织学研究显示前外侧韧带符合韧带组织的特征。前外侧韧带对维持膝关节内旋稳定有重要作用。前外侧韧带损伤应该早期诊断、早期治疗。其诊断不仅依靠影像学检查,还要结合临床查体;手术方式一般为关节外肌腱固定。结论 前外侧韧带是与Segond骨折相关的韧带结构,有助于维持膝关节内旋稳定性。目前对其损伤后的手术治疗方式尚无统一定论,有待进一步深入研究。     

膝前交叉韧带自体替代物的生物力学研究

对膝前交叉韧带、髂胫束、髌韧带中间1/3和半腱肌腱进行了力学性能测试和组织结构观察、结果显示,四种结构均由胶元纤维束组成,其最大拉应力近似;由于纤维束排列方向不同,各结构延伸率有较大的差异;三种替代物中以髂胫束的力学性能和纤维排列形式与前交叉韧带较为接近。实验结果提示,髂胫束是前叉韧带修复术中较好的自体替代物.     

膝关节前外侧韧带测量及其临床意义

目的 测量膝关节前外侧韧带（ALL)的相关解剖学参数及即其出现率、形态和解剖关系。 方法 选择国人成人尸体下肢标本40例,解剖膝关节前外侧区域,分离前外侧韧带,观察其与邻近组织的位置关系,并测量膝关节屈曲90°时其长度,关节线水平的宽度以及厚度。 结果 膝关节屈曲90°时,前外侧韧带的长度为（38.04±6.14）mm,关节线水平的宽度为（5.39±2.80）mm,厚度为（0.93±0.52）mm。 结论 前外侧韧带作为膝关节前外侧一个独特的、确切存在的韧带,对维持人体膝关节稳定性具有重要意义。     

PubMed数据库中有关股前外侧皮瓣的文献计量学分析

目的了解股前外侧皮瓣的发展现状、研究水平,推断研究热点及预测学科发展趋势。方法应用文献库管理软件Endnote for Windows,以美国PubMed的资料为统计源,对有关股前外侧皮瓣的研究文献进行计量学分析。结果1996年1月~2006年8月间,PubMed共收集股前外侧皮瓣研究文献236篇,中国和美国文献各有77篇,占全部文献的65.2%。游离皮瓣、穿支皮瓣、岛状皮瓣、超薄皮瓣及旋股外侧动脉降支的词频累计达到97.5%。该类皮瓣的文献量自2002年后成倍数增长,占所检文献总量的80%。结论股前外侧皮瓣文献的主要产文国是中国和美国。《Plast Reconstr Surg》等9种英文期刊为其主要载体;游离皮瓣、穿支皮瓣、超薄皮瓣、岛状皮瓣为股前外侧皮瓣研究中的热点与重点。研究方法正逐渐向放射造影及三维可视化发展。     

锌元素与脑发育研究的文献计量学分析

检索1991－2000年CBMdisc和Medlin光盘数据库，通过对检出的10年间关于锌元素与脑发育研究的文献题录进行统计和分析，探讨该方面的研究进展和发展趋势。     

自体髌韧带重建前交叉韧带后膝关节外侧感觉障碍的研究

目的：研究自体B-P-B中1／3组织重建ACL后膝关节外侧皮肤感觉障碍的发病原因。方法：(1)对21例临床用自体B—P—B中1／3组织重建ACL的患者随访5～6年，测量其膝关节切口外侧皮肤感觉麻木范围。(2)解剖观察成人新鲜尸体标本3具6例和附腐固定的成人尸体标本15具30例的隐神经髌下支的分布范围。结果：术后患者均不同程度的出现膝关节外侧皮肤感觉障碍；隐神经髌下支自深筋膜穿出后，在胫骨内侧髁下方发出分支，横行跨过髌韧带分布至膝外侧皮肤。结论：隐神经髌下支分布到膝外侧皮肤，用自体B-P-B中1/3组织重建ACL在取材时可致其损伤，是术后并发膝外侧皮肤感觉障碍的原因。     

前交叉韧带重建后康复训练研究热点的可视化分析

背景:前交叉韧带损伤和重建手术的数量逐年增高,前交叉韧带重建后患者恢复活动和运动的安全性、速度,主要取决于科学的康复方案.目的:应用CiteSpace可视化分析软件绘制科学知识图谱并结合相关研究证据,探讨近11年康复训练在前交叉韧带重建后运用的研究现状、研究热点及趋势,以期后续对前交叉韧带重建的研究和临床治疗提供思路和...     

The anterolateral ligament is a distinct ligamentous structure: A histological explanation

Background

The aim was to determine whether the anterolateral ligament (ALL) had a histological structure that defined it as a real ligament.

3T MRI-based anatomy of the anterolateral knee ligament in patients with and without an ACL-rupture: Implications for anatomical anterolateral ligament reconstruction

BackgroundAnterior cruciate ligament (ACL) rupture is often accompanied by an injury to the anterolateral ligament (ALL) of the knee. Detailed knowledge of the ALL attachments in ACL-ruptured patients is essential for an anatomical ALL reconstruction to avoid knee over-constraint and successfully treat the residual rotational instability. The aim of the present study was to investigate the three-dimensional (3D), topographic anatomy of the ALL attachment in both ACL-ruptured and ACL-intact patients using 3 Tesla magnetic resonance imaging (3T MRI).MethodsIn the present, retrospective case-control study, the magnetic resonance images of 90 knees with an ACL-rupture and 90 matched-controlled subjects, who suffered a non-contact knee injury without an ACL-rupture, were used to create 3D models of the knee. The femoral and tibial ALL footprints were outlined on each model, and their position was measured using an anatomical coordinate system.ResultsThe femoral origin of the ALL was located 4.9 ± 2.8 mm posterior and 3.8 ± 2.4 mm proximal to the lateral epicondyle in a non-isometric location in control subjects. In ACL-ruptured patients, it was located in a more posterior and distal, at 6.0 ± 1.9 mm posterior and 2.4 ± 1.7 mm proximal to the lateral epicondyle (p < 0.01), also in a non-isometric location. No difference was found in the tibial ALL insertion between groups.ConclusionThe femoral ALL origin was significantly different in ACL-ruptured patients compared to ACL-intact patients. The recommended femoral tunnel position for the anatomical ALL reconstruction, does not represent the femoral ALL origin in the ACL-ruptured knee.     

The anterolateral ligament: Anatomic implications for its reconstruction

Background

The purpose of this study was to define the best anatomic parameters with which to perform an accurate anterolateral ligament (ALL) reconstruction. These parameters were anatomical insertions, allowing favorable isometry, length variation during flexion, and anthropometric predictors of ALL lengths.

Lateral collateral ligament and anterolateral ligament of the knee – A morphological analysis with orthopedic significance

BackgroundThe lateral collateral ligament (LCL) is the chief stabilizer of the lateral aspect of the knee to varus forces. Studies have confirmed the function of the anterolateral ligament (ALL), which improves the lateral knee stability by preventing excessive internal tibial rotation. Clinically, a persistent instability following anterior cruciate ligament reconstruction may be due to damage to the anterolateral structures. The finding has created a novel interest in anterolateral extra-articular operations.MethodsThis observational, cross-sectional study involved 42 dissected adult knees. The variations in morphology and morphometry of the LCL were identified and classified. The prevalence and the variabilities in the ALL were also noted.ResultsThe variations in the shape of the LCL were classified into four types: (1) cord, (2) band, (3) mixed, and (4) inverted Y shaped, with a frequency of 69.04, 26.20, 2.38, and 2.38% of specimens, respectively. The cord type measured 50.4 ± 2.7 mm in length and 5 ± 0.9 mm in width. In comparison, the band type measured 50.1 ± 4.2 mm in length and 9 ± 1.6 mm in width. The ALL was identified in four (9%) of the specimens with a mean length of 35 ± 0.9 mm. Two types of ALL were observed, membranous wideband and distinct cord-like ALL.ConclusionThe anatomy of the lateral structures of the knee is inconsistent. The study has attempted to classify the different shapes of the LCL along with the frequency and prevalence of the ALL. Orthopedic surgeons and radiologists must note the LCL morphology and prevalence of the ALL due to their clinical implications.     

Influence of anterolateral ligament injuries on stability and second-look arthroscopic findings after allograft transtibial anterior cruciate ligament reconstruction

Background

The purpose of this study was to evaluate the influence of anterolateral ligament (ALL) injuries on stability and second-look arthroscopic findings after anterior cruciate ligament (ACL) reconstruction.

The relationship between a Segond fracture and meniscus injury in patients with anterior cruciate ligament tears

BackgroundSegond fracture may be identified when an anterior cruciate ligament (ACL) tear is diagnosed, and it has historically been considered a sign of significant knee trauma indicating intra-articular injury. There are few studies on the correlation between a Segond fracture and meniscus injury. The purpose of this study was to evaluate the relationship between a Segond fracture and meniscus injury in patients with ACL tears.MethodsA retrospective review of all patients undergoing acute ACL reconstruction (less than 1 month from the time of injury) between 2013 and 2020 was performed. The absence or presence of a Segond fracture was confirmed using preoperative radiographs. Demographic data (age, sex and body mass index), injury variables (time from injury and mechanism of injury) and arthroscopic features (meniscal or chondral injury) were analysed to investigate the relationship between a Segond fracture and meniscus injury.ResultsA total of 427 patients were included in the study. The incidence of Segond fractures was 12.4%. Among the patients with a Segond fracture, 15 patients were injured playing soccer (28.3%), 11 patients were injured playing basketball (20.8%), eight patients sustained the injury during racquet sports (15.1%), five patients (9.4%) were injured during less popular sports (such as skiing, ice-skating and boxing), and 14 patients (26.4%) were injured by contact mode of injury. A Segond fracture was a significant risk factor for lateral meniscus tears in patients with ACL tears (adjusted odds ratio, 1.938; 95% confidence interval, 1.078–3.481; P = 0.027).ConclusionThe incidence of Segond fractures in patients with acute ACL tears was higher than that reported in previous studies. A Segond fracture could increase the risk of a lateral meniscus tear in patients with an ACL tear.