唧唧堂编辑二朵2013-12-27 12:01 AM

Anatomy of the anterolateral ligament of the knee 膝盖外侧韧带解剖学

In 1879, the French surgeon Segond described the existence of a 'pearly, resistant, fibrous band' at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as '(mid-third) lateral capsular ligament', 'capsulo-osseous layer of the iliotibial band' or 'anterolateral ligament', and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's 'pearly band', hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function. 论文摘要: 法国外科医生Segond(首次)于1879年(提出假设)描述了人膝关节外侧存在一种珍珠色强韧的纤维带,这种纤维韧带附着连接在同名的Segond断面处。到目前为止,围绕该解剖结构之谜可以从它令人混淆的繁杂重名中窥见一斑,比如“(中三)外侧关节囊副韧带”,“囊性骨层的髂胫束”或“前外侧韧带”,但至今尚未有任何明确的解剖学描述(来解决该问题)。在这项研究中,我们解剖了41份非配对的人类尸体膝盖来对Segond曾所假设描述的珍珠色韧带的存在和特征进行了探索研究,该韧带从此被命名为“前外侧韧带”(ALL)。我们也对在该韧带处的股骨和胫骨附着物,它的过程以及它与邻近解剖结构的关系进行了(一系列)定性和定量的研究。在所有41份尸体膝关节样本中只有其中一份可以清晰地与前外侧关节囊区分开来,我们发现前外侧韧带具有一个定义明确的韧带结构。前外侧韧带起始于股骨外上髁突出,稍稍位于外侧副韧带起始处前面,尽管我们对该两个结构间起连接作用的纤维都进行了观察。该前外侧韧带与近端胫骨前外侧形成了倾斜路线,且与外半月板有强韧附着物相连接,因而包裹了下面的外侧膝状体动脉和静脉。它在胫骨前外侧的插入位置正位于胫骨前肌结节(惹迪氏结节)和腓骨头尖的中间,且与髂胫带(ITB)彻底分开。前外侧韧带被认为是一个位于人类膝关节前外侧确切明显的韧带结构,且具有稳定的起始和插入位点特征。通过提供详尽的前外侧韧带的解剖特征,该研究揭开了长期围绕有关连接股骨和胫骨外侧的韧带结构是否存在这一迷团。鉴于该韧带的结构和解剖学位置,前外侧韧带被假设认为起着控制胫骨内旋因而影响轴移现象的功能,尽管我们仍需进行更深入的研究来探讨其生物力学方面的功能。






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