膝关节后纵隔与后交叉韧带下止点的解剖关系及临床意义

目的 探讨膝关节后纵隔与后交叉韧带(PCL)下止点的解剖关系及其在PCL重建中的临床价值. 方法 解剖22例新鲜冷冻膝关节,将PCL在屈膝90°下按纤维张力的不同分为前外束和后内束,解剖出它们在胫骨上的足迹,并用墨汁标记足迹的轮廓;使用带标尺的数码相机测量PCL前外束、后内束胫骨止点中心点与后纵隔的水平距离,并同时测量两束止点中心点与外侧胫骨平台后软骨缘上表面的垂直距离. 结果 膝关节存在一个从前至后的纵隔结构,其前方与脂肪垫、翼状皱襞或黏膜韧带相连,中间位于前、后交叉韧带之间,后方形成膝关节的后纵隔.在22个膝关节中,8个膝关节的后纵隔从PCL的外缘绕过以后止于后关节囊,占36.36%;14个膝关节的后纵隔在PCL前方分叉,包绕PCL后止于后关节囊,占63.64%.PCL前外束胫骨止点中心点距离后纵隔内侧的水平距离(0.90±2.40)mm,距离外侧胫骨平台后软骨缘上表面的垂直距离是(3.25±1.20)mm.后内束胫骨止点中心点距离后纵隔内侧的水平距离为(4.35±2.46)mm,距离外侧胫骨平台后软骨缘上表面的垂直距离为(6.91±1.57)mm. 结论 膝关节后纵隔与PCL下止点的解剖关系密切,后纵隔可以成为PCL单束重建和双束重建手术中胫骨止点定位的重要解剖标志之一.

Anatomical study on the relationship between the posterior sagittal septum of knee and the tibial insertion of posterior cruciate ligament

Objective to investigate the anatomical relationship between the posterior sagittal septum of knee and the tibial insertion of posterior cruciate ligament (PCL). Methods Twenty two fresh frozen adult cadaveric knee joints were dissected. With the knee flexed to 90 degrees, PCL was divided into anterolateral bundle and posteromedial bundle. The outlines of the footprints of the two bundles were marked with ink. The posterior sagittal septum of knee and the insertion of PCL on tibia were observed and measured. Results There was a sagittal septum in the knee, the anterior of which was connected with fat pad, alar fold or mucous ligament. The middle part of the sagittal septum lied between the anterior and posterior cruciate ligament, the postetior part of the sagittal septum formed the posterior septum of the knee. Eight of the 22 knees (36.36%), the posterior sagittal septum passed the PCL at lateral side. And 14 of the 22 knees (63.64%), the sagittal septum passed around the bundle of PCL. Moreover, the center of the tibial insertion of anterolateral bundle of PCL located at （0.90±2.40）mm medially to the posterior sagittal septum ,and at （3.25±1.20）mm beneath the lateral tibial surface. The posteromedial bundle was seated at （4.35±2.46）mm medially to the posterior sagittal septum and at （6.91±1.57）mm beneath the lateral tibial surface. Conclusion The anatomical relationship between the posterior sa