膝交叉韧带重建术中切取自体腘绳肌肌腱安全区的临床解剖学研究

目的探讨膝关节屈曲状态下切取胭绳肌肌腱的安全区和安全角度。方法选择膝关节标本15例，分离出隐神经及分支。以髌韧带内缘在髌骨下极水平处定为点B，以髌韧带内缘在胫骨结节的止点处定为点A，以A、B点的中点定为点C。分别测量点A和点C至隐神经、髌下神经的距离，通过计算得出手术安全区范围和切口角度。结果切取胴绳肌肌腱时，在点A（胫骨结节）水平上为同时避免损伤隐神经和髌下神经切口位置必须在点A内侧3．4—5．9cm，切口安全角度为50°。结论在切取半腱肌股薄肌时膝关节屈曲90°、切口在胫骨结节内侧3．4—5．9cm、切口角度50°可避免神经损伤。

A study of a safe area and angle of harvesting autogenous tendons for anterior cruciate ligament reconstruction

Objective To determine a safe area and angle with the knee in flexion. Methods Fifteen adult cadaver knees were dissected and both the saphenous nerves and their infrapatellar branch were exposed. Point B was defined as the insertion point of medial side of the patellar tendon on the inferior border of patella. Point A was the insertion point of medial side of the patellar tendon on the superior edge of tibial tuberosity. Point C was the point equidistant from point A and B. The distances from point A and point C to the saphenous nerve and to the infrapatellar nerve were measured separately. The safe point and angle was calculated. Results To avoid injury to the saphenous nerve and the infrapatellar nerve meanwhile when for harvesting of the semitendinosus and graeilis tendons, the operation incision should be performed at a distance of 3.4 -5.9 cm from medial edge of tibial tuberosity. The incision angle was 50°. Conclusion This safe area and angle is found to be on the plane of tibial tuberosity. It is possible to avoid injury to nerves if place the knee in a 90° flexed position and the incision is placed between 3.4 and 5.9 cm from the tibial tuberosity and the incision angle was 50°.