膝关节后外侧角结构的解剖特点与生物力学特性

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详细

背景。膝关节后外侧角结构的损伤较为罕见，但通常由高能量机制引起，并导致膝关节快速进展的退行性病变。目前，对于在手术治疗中修复膝关节后外侧角受损结构是否能够实现有效稳定性， 尚无一致意见。探讨后外侧角解剖结构对膝关节后外侧旋转不稳定性的影响，具有重要的理论和实践意义。

研究目的。研究腘肌腱和腓骨侧副韧带的解剖特点和形态计量参数，特别是其附着点在股骨上的分布，以及这些结构在膝关节后外侧旋转与内翻不稳定性中的作用。

材料与方法。本研究为单中心综合性局部解剖学研究，基于50具未固定下肢解剖学标本 （30名女性，20名男性），年龄范围为30至60岁，均因非骨骼系统病理原因死亡。通过精确解剖对膝关节后外侧角的腘肌腱和腓骨侧副韧带的结构进行详细研究，并记录其在股骨上的附着区域的形态计量特点。随后，通过逐步切割后外侧角结构，评估其对膝关节后外侧旋转不稳定性、胫骨内翻偏移（内翻应力测试）及胫骨后移（后抽屉试验）的影响。

结果。当切断腓骨侧副韧带时，膝关节的最大内翻角偏移为5°± 3.0°。切断腘肌腱后，胫骨外旋最大增加为11°± 1.5°。切断后交叉韧带导致胫骨相对于股骨的最大后移量为9（7.9~10.2）毫米。

结论。本研究详细分析了膝关节后外侧角结构的解剖和功能特点。研究结果表明，腘肌腱在膝关节后外侧旋转不稳定性中具有主导作用，而腓骨侧副韧带在内翻不稳定性中起主要作用。这对于膝关节不稳定性患者的诊断和手术治疗具有重要意义。

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作者简介

Marsel R. Salikhov

Vreden National Medical Center for Traumatology and Orthopedics

Email: virus-007-85@mail.ru
ORCID iD: 0000-0002-5706-481X
SPIN 代码: 2009-4349

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Vladislav V. Avramenko

Saint Petersburg State Pediatric Medical University

Email: avramenko.spb@mail.ru
ORCID iD: 0000-0003-0339-6066
SPIN 代码: 4632-9953
俄罗斯联邦, Saint Petersburg

Gleb E. Batalov

Vreden National Medical Center for Traumatology and Orthopedics

编辑信件的主要联系方式.
Email: Batalovgl@yandex.ru
ORCID iD: 0009-0006-5266-8530
俄罗斯联邦, Saint Petersburg

Ekaterina V. Sannikova

Vreden National Medical Center for Traumatology and Orthopedics

Email: sannikovaekaterina@rambler.ru
ORCID iD: 0000-0002-9171-1697
SPIN 代码: 2715-4820

MD, PhD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Topography of the posterolateral corner structures. Specimen of the left knee joint, lateral view: 1, fibular collateral ligament (FCL) attachment zone on the femur; 2, popliteus tendon (PT) attachment zone on the femur; LMFC, lateral femoral condyle

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3. Fig. 2. Example of measurements of attachment zones in the posterolateral corner. Specimen of the left knee joint, lateral view: VFCL, vertical dimension of the fibular collateral ligament attachment site on the femoral epicondyle; HFCL, horizontal dimension of the fibular collateral ligament attachment site on the femoral epicondyle; VPT, vertical dimension of the popliteus tendon attachment site on the femoral epicondyle; HPT, horizontal dimension of the popliteus tendon attachment site on the femoral epicondyle; FCLL, length of the fibular collateral ligament; PTL, length of the popliteus tendon; DCA, distance between the centers of the popliteus tendon and fibular collateral ligament attachment sites

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4. Fig. 3. Popliteofibular ligament specimen of the left knee joint in the popliteal region: PT, popliteus tendon; FCL, fibular collateral ligament; PFL, popliteofibular ligament

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5. Fig. 4. Example of the measurements (mm) of the attachment zones in the posterolateral corner: VFCL, vertical dimension of the fibular collateral ligament attachment site on the femoral epicondyle; HFCL, horizontal dimension of the fibular collateral ligament attachment site on the femoral epicondyle; VPT, vertical dimension of the popliteus tendon attachment site on the femoral epicondyle; HPT, horizontal dimension of the popliteus tendon attachment site on the femoral epicondyle; DCA, distance between the centers of the popliteus tendon and fibular collateral ligament attachment sites

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6. Fig. 5. Degree of external rotation following the transection of the posterolateral corner structures a, intact knee joint (baseline); b, following popliteus tendon transection; c, following fibular collateral ligament transection; d, combined effect after multiple structure transections

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