膝内侧稳定结构的解剖特征与软组织平衡的关系

目的:观测国人膝内侧结构解剖学特点,为膝关节置换术中内侧结构软组织平衡的松解策略选择提供形态学依据.方法:80例固定及20例新鲜成人膝关节标本,解剖观察内侧结构的组成及其位置与形态学特点.结果:膝关节内侧面支持结构包括内侧副韧带复合体和半膜肌复合体等结构,可分为3层.内侧副韧带复合体包括内侧副韧带(medial collateral ligament,MCL)深、浅两层,可分为前纵部和后斜部两部分.MCL前纵部以间接止点形式融入胫骨平台关节面下50～60 mm,鹅足深方的胫骨内侧骨面骨膜,长约92mm,中部宽约15mm后斜部纤维以腱板起于股骨内卜髁后侧,下止点弥散;在关节间隙处,后斜部纤维与其深方第3层(内侧关节囊)愈着,被半月板、冠状韧带固定.MCL深层实际上为膝内侧关节囊增厚,自股骨内上髁下半周缘骨面垂直向下走行,连接内侧半月板,止于胫骨平台内侧缘中点关节面下0.8～1.5cm骨面,并与半膜肌腱横臂融合.膝关节后内侧区域为半膜肌腱鞘和半膜肌腱的9处附丽所加强,维持膝关节后内侧角稳定.结论:基于膝关节内侧结构解剖特点,膝关节置换术中软组织平衡可以做到微创化、选择性的松解.尽量保护其结构和功能的完整对术后功能有重要意义.

Applied anatomy of the medial part of human knee and. its relationship with soft tissues balance

Objective: To provide morphological data of the medial part of the knee joint for soft tissues balancing in total knee art.hroplasty (TKA). Methods: To measure and observe anatomic features on 20 fresh adult human cadaveric knees and 80 formaldehyde-fixed ones adopting microsurgical techniques. Results: The medial supporting structures of knee composed of the medial collateral ligament complex and semimembranons muscle complex which could be divided into three layers. Anterior portions of the medial collateral ligament inserted into anteromedial tibia, inferiorly to the tibial plateau about 50-60 ram. The posterior oblique portions mixed with the third layer (medial joint capsule) together, and fixed by medial meniscus and coronary ligament.The tendinous sheath and tendon of semimembranous muscle strengthened to the posteromedial area of knee,and could be divided into 9 parts. Furthermore, the tendon inserted into the superficial and deep layers of MCL. Articular capsule reached inferiorly into tibial plateau 0.8～1.5 cm under the facet joint. Conclusions: In view of the anatomical characteristics of the medial part of knee, selectional and mini-trauma soft tissue balancing in TKA could be achieved.