前交叉韧带与髁间窝的解剖学比较及相关性研究

doi:10.3877/cma.j.issn.1674-134X.2024.01.012

目的

观测前交叉韧带(ACL)及髁间窝的形态和大小，探究其相关性及临床意义。

方法

福尔马林固定的人膝关节标本来自于中山大学中山医学院人体解剖教研室2021～2022年教学用的成人尸体。共解剖50例(左膝24例，右膝26例)。记录髁间窝的高，宽度以及宽高比，前交叉韧带分别在屈曲90°和0°时的长度，宽度以及厚度，并且分别记录了前交叉韧带股骨直接止点和间接止点的长轴，短轴和长短轴比，同时对髁间窝的宽高比和前交叉韧带直接止点的长短轴比做Pearson检验。

结果

未发现ACL有明显分束；ACL股骨直接止点的长短轴比和髁间窝宽高比呈显著负相关(r＝－0.656)；50例标本中46例的ACL股骨止点可分成间接止点和直接止点，4例ACL股骨止点呈椭圆形，无明显间接止点，其中直接止点形态为扁带样结构，间接止点呈扇形展开。

结论

本研究测得ACL解剖学数据符合国人指标，髁间窝相关指标在ACL重建术中具有重要临床意义，其回顾性分析将为ACL重建术式的设计提供重要依据。

关键词: 膝关节, 前交叉韧带, 解剖学, 对比研究

Objective

To observe the morphology and size of the anterior cruciate ligament (ACL) and intercondylar fossa, and to investigate their correlation and clinical significance.

Methods

Fifty knee specimens (24 cases in the left knee and 26 cases in the right knee) fixed with formalin were dissected, the height, width, and aspect ratio of the intercondylar fossa, the length, width, and thickness of the anterior cruciate ligament (ACL) at 90° and 0° of flexion, respectively, and the long-axis, short-axis, and long-short-axis ratios of the direct and indirect femoral stops of the ACL, respectively, were recorded, and Pearson's test was performed to determine the aspect ratios of the intercondylar fossa and the short-short-axis ratios of the ACL's direct stops.

Results

No significant fasciculation of the ACL was found. The length-short axis ratio and intercondylar fossa width-height ratio at the direct femoral stop of the ACL were significantly negatively correlated (r =-0.656). The ACL femoral stops in 46 of 50 specimens could be divided into indirect and direct stops, and 4 ACL femoral stops were oval with no obvious indirect stops, where the direct stop morphology was ribbon-like and the indirect stop was fan-shaped Expand.

Conclusion

The anatomical data of ACL are in accordance with the national indexes, and the indices related to the intercondylar fossa have important clinical significance in ACL reconstruction, and its retrospective analysis will provide an important basis for the design of ACL reconstruction.

Key words: Knee joint, Anterior cruciate ligament, Anatomy, Comparative study

图1 膝关节屈曲0°时ACL的解剖学特征示意图注：AB-ACL后内侧缘起止点；CD-ACL前外侧缘侧起止点

Figure 1 Anatomical features of the ACL at 0° of knee flexion Note: AB-enthesis of the ACL posteromedial margin; CD-enthesis of the ACL anterolateral margin

图2 股骨ACL直接和间接止点长轴和短轴位置标记示意图注：AA’-直接/间接止点的长轴；BB’-直接止点的短轴；CC’-间接止点的短轴

Figure 2 Diagram of long and short shafts markers of direct/indirect entheses of femoral ACL Note: AA’- longitudinal shaft of direct/indirect enthesis; BB’- short shaft of direct enthesis; CC’- short shaft of indirect enthesis

图3 髁间窝解剖形态测量方法示意图注：AA’-髁间窝1/2宽；BB’-髁间窝开口宽度；H-髁间窝高度

Figure 3 Anatomical morphometric measurement of the intercondylar fossa Note: AA’-1/2 width of intercondylar foss; BB’-opening width of intercondylar fossa; H-height of intercondylar fossa

图4 髁间窝宽高比与ACL直接止点长短轴比相关性分析

Figure 4 Correlation analysis of intercondylar fossa aspect ratio and longitudinal and short axises of ACL direct enthesis

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Anatomical observation and correlation between anterior cruciate ligament and intercondylar fossa

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Anatomical observation and correlation between anterior cruciate ligament and intercondylar fossa