人膝关节前_后交叉韧带解剖研究及临床意义_刘秀梅

·论著·人膝关节前、后交叉韧带解剖研究及临床意义

刘秀梅　陶澄　肖东民

(中南大学湘雅二医院超声科,湖南　长沙　410011)

[摘要]【目的】对国人前交叉韧带(A CL)、后交叉韧带(PCL)的解剖结构进行观察研究,掌握更为详细的

解剖资料,为临床治疗提供参考。【方法】对42例人膝关节标本的交叉韧带进行观察,测量其长度、宽度和厚

度以及附着区的形态;应用显微外科技术对14具新鲜冷冻PC L标本进行解剖,并行组织学观察,掌握其微观

结构,其结果与国外文献资料比较。【结果】国人PCL长31.0～37.0(33.8±1.3)mm,两端粗大,最窄处位于

中间。ACL长25.0～36.0(29.6±1.1)mm,前、后交叉韧带均为不可分割的完整韧带,由许多纤维组成并发

生扭转,纤维束相互穿插融合。病理切片示PCL近端和远端纤维分布松散,中段紧密。【结论】前、后交叉韧

带是完整的韧带,对维持膝关节稳定有一定作用。国人交叉韧带长度可能短于西方人。

[关键词]　膝关节;　前交叉韧带/解剖学和组织学;　后交叉韧带/解剖学和组织学

Anatomical Study and Clinical Value of the Chinese C ruciate Ligament LIU Xi u-mei,

　T AO Cheng,　X I AO Dong-min(Department of Orthopedics,Xiangy a S econd Hospita l,Changsha

410011,China)

[Abstract]【Objectiv e】To measur e the cr ucia te lig ament fiber,provide more detailed anato mic data for the

diag nosis and t reatment o f cruciate ligament injury.【M ethods】F or ty two adult specime ns o f the crucia te lig a-

ment we re measured of its fibe r's length,w idth and thickne ss.T he shape of femoral and tibial inse rtio ns w as

also described.Four teen fre sh fro zen cruciate lig ament specimens wer e dissected under o pe rative micro sco pe.

T issue o bser vatio n w as also perfo rmed to see its ar chitec ture.【Results】T he posterior cruciate ligment(PC L)

was33.8mm lo ng and the anterior cruciate ligament(A CL)w as29.6mm,the narr owe st sectio n wa s in the

middle.Cruciate lig ament w as a continual ana to mic unit.T he fiber s w ere unsepa rable unde r micro surg ical dis-

sectio n and many fibers connected each other.T he leng th and te nsio n of the fiber s in different par t we re

changeable during the movement o f knee joint.T he fiber s nea r the o rig in a nd inser tion wer e mo re dispersal

tha n tho se of the middle level.【Conclusion】①The leng th o f Chinese crucia te ligament maybe sho rter than that

of the wester ns.②Both A CL and PCL a re continual ligaments.

[Key words]　knee joint;　anterio r cruciate ligament/A H;　po sterio r cruciate ligament/A H

[中图分类号]　R323.72　[文献标识码]　A　[文章编号]　1671-7171(2006)07-1085-03

例,如并发AOSC时,或肝内胆管结石较少、分散,病变不甚严重者。但研究表明,前者绝不是一种“根治性”手术,反而导致残石、结石复发、反复的胆道感染,甚至引起胆管细胞癌变。本组病例中系再手术者18例(34.6%),既往平均手术1.5次,皆因肝内胆管病变未彻底根除。肝内胆管结石总是沿着胆管树呈严格的区域性分布,同时存在多处的肝胆管狭窄,而这些不易被手术纠正的2～3级胆管引起的胆汁淤滞可导致结石复发,术后胆管炎反复出现。笔者的经验是,如果肝功能正常,残肝可以代偿,就尽量保证足够的切肝范围,去除可疑的病灶肝。再联合施行胆肠吻合术,以解决炎性胆汁凝滞问题。本组病例中右半肝切除14例(26%),术后随访效果好。而5例(9%)因全肝结石并胆汁性肝硬化、门脉高压导致肝切除受限,术后残石与此有关。术中的胆道造影及胆道镜探查可减少残石的发生率。

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(本文编辑:詹道友)　[收稿日期]　2006-04-11