【作者】 于春水；

【导师】 廉宗澂； 韩悦； 李云生；

【作者基本信息】 天津医科大学 ， 影像医学， 2002， 博士

【摘要】 膝关节非常见韧带和肌腱结构(简称为：非常见结构)是指除膝交叉韧带、股四头肌肌腱及髌韧带等较大结构以外的韧带和肌腱类结构，其形态多不规则，大小及行程变异较大，常不为人们所熟悉，但对维持膝关节的稳定同样起重要作用。根据其所处位胃可将其分为：膝前内侧部、膝前外侧部、膝后外侧部、膝后部和关节囊内结构等五部分。 第一部分：膝关节非常见韧带和肌腱类结构的大体解剖学研究 目的：通过大体解剖学方法，明确各结构的出现率、位置、形态、大小、方向、起止点、走行及毗邻关系，为影像诊断学和外科手术学提供解剖学依据。 材料和方法：采用40侧成人尸体膝关节标本，进行大体解剖学观测。 结果： 1．膝前内侧部结构包括：内侧副韧带(100％)、内侧髌股韧带(100％)、内侧髌胫韧带(100％)和内侧髌半月板韧带(80％)；膝前外侧部结构包括：髂胫束(100％)、横韧带(100％)、上髁髌韧带(35％)和外侧髌胫韧带(85％)；膝后外侧部结构包括：股二头肌肌踺(100％)、腓侧副韧带(100％)、腘肌(100％)、腘腓韧带(100％)、弓状韧带(100％)和小豆腓骨韧带(55％)；膝后部结构包括：胫骨后韧带(70％)和腘斜韧带(100％)；关节囊内结构包括：膝横韧带(80％)、板股后韧带(80％)和板股前韧带(7．5％)。 2．描述了上述结构的形态、位置、起止点、走行和毗邻关系。 3．测量了膝非常见结构的大小及各结构长轴与骨性标志所成的角度。 4．本文根抓腘肌走行方向的不同将其分为：肌腹起始部、肌肉肌腱连接部、腘肌腱斜行部和腘肌腱股骨部四部分。 第二部分：膝关节非常见韧带和肌腱类结构的断层解剖学研究 目的：通过断层解剖学研究，明确膝关节非常见结构在冠状、矢状和水平切片上的形态、位置和毗邻关系，为影像诊断学提供断层解剖学依据。 材料和方法：将12侧膝关节标本，每4侧为一组分为3组，应用火棉胶包埋法分别制成冠状、矢状和水平切片。观察各结构在不同层面的形态、位置和毗邻关系。 结果： 1．水平切片可以完整地显示内侧髌股韧带、横韧带和内侧斜半月板半月板韧带； 博D－仙九”庄｝K1【（冠状切片可以显示删王束、股二头肌肌脏、内侧剐韧带、啡侧副韧带、内侧敝卜韧带。胭脐韧带和弓状韧带等结构；矢状切片可以巳示内侧骰呸韧带、n阶韧十。小＿L刊卜3f韧带和扳股F韧带等纠构。 2．明确了各结构在不同层面的形态、位置和毗邻关系。 第三邮分：膝关节非常见结构的MRI脉冲序列与定位研究 目的：是通过胚骨标本和膝关节MRI研究，找出适合韧带定位与解剖测量的骨性标志，并确定显示膝关节非常见结构长轴方向的定位方法。通过对W 脉冲序列的研究找出适合临床应用的MR工检查脉冲序列。 材料和方法：迎过对n例u忖标本的观测选择定位膝义V的丹性标忘。灭们J（）例干常膝关节川Z图像进7了观经以验证所选择骨性标志的可靠性，并确定斜位像扫州n定位方法。对盼侧正常膝关节进行肛T川、％飞们、％叫工、旺厂WI、引R T从I。PASTA FSE T；BI，FSTIR、FLAIR和 FE3D扫描。采用双盲法分别评价并比较 9种脉冲序列对膝关节韧带、肌肉和肌健结构的显示能力。 结果： 1．胜骨踝前缘平面和胚骨夕「侧平台是较为稳定的骨性标志c 2 以正中矢状面、足示胜脐关节的矢状面和显示股叫关节的冠状面为定位像，3。l掐平面与上还骨性标志成一定角度，即可确定各种斜位像的扫拟方向。 3．SE TBI、SE PDI和厂IR T。WI对韧带、肌肉和肌健结构的显示，明显优于其它脉冲序列，SE T们和1二R乙WI所需时间较短，是史为头用的显示方法。 第四部分：膝关节非常见韧带和肌健类结构的 MR研究 目的：通过对尸膝和正常人膝关节的WI研究，以确定膝关节非常见结构中各结构的最佳显示方案，并明确各结构在常规和斜位洲成像上的正常表现c 材料与方法：对川侧尸膝和30侧正常膝关节分别进行横轴位、冠状位、）一V、。补斜冠状位。br 后刹k状‘、、T丁 斥斜冠状位、1于 内斜矢状应、？T 外斜夭状广。70“外斜矢状应和70”内斜矢状位门M删十观察膝非常见结构的显示情况及在不问方位成像上的MRI表现。 结果： 1 内侧鸵股韧带、横韧带和斜半月板半月板韧带在项轴像床示最什c 】删壬束门D二头肌肌膻和内侧副韧带在冠状像或n斜厄状斜位像V叫小川＿； 3．内侧骸旺韧带在冠状像或矢状像显示最伴。 4 内侧骸半月板韧带和外侧骸胜韧带分别在7丁 内斜矢状斜位像和m’外斜X状斜位像显示较好。 5 眯侧副韧带在””后斜冠状斜位像显示最H：。 6 胭肌和眶肌推在、厂”内斜矢状斜位偕和6r6川冠状斜广伸V示尺仕 了 阳【w汕。1。‘。’h门’门引＼l、JJ川。”呕。XIl）”，‘、们＼。卜，们、KV。人‘【 博【儿卜〔生学位a义更多还原

【Abstract】 The uncommon ligamentous and tendinous structures(ULTS)of the knee include the ligamentous and tendinous structures except for the bigger structures, such as the cruciate ligaments, the tendon of the quadriceps lemons muscle and patellar tendon. They are irregular in shape, variable in size and course, and still unfamiliar to us. Nevertheless, they are playing an important role in maintaining the stability of the knee. According to their location, they can be divided into five pans: anteromedial. anterolateral, posterolateral, posterior and intracapsular parts.PART I: The gross anatomic study of ULTSObjective: Through the methods of gross anatomy, to determine the occurrence rate, location, shape, size, direction, origin and insertion, course and adjacency relationships of the individual structures, and to provide the anatomic foundation for imageology and surgery.Materials and Methods: Forty knees of adult cadavers were chosen to be observed about the gross anatomy.Results:!.The anteromedial part of the knee includes: the medial collateral ligament (MCL,100%), the medial patellotibial ligament (MPTL, 100%),the medial patellofemoral ligament (MPFL,100%) and the medial patellomeniscal ligament (MPML,80%). The anterolateral part: Iliotibial band (ITB,100%), lateral transverse ligament (LTL,100%). epicondylopatellar ligament (EPL,35%) and lateral patellotibial ligament (LPTL,85%). The posterolateral part: Biceps femoris muscle (BFM,100%), fibular collateral ligament (FCL,100%), popliteus muscle (PM,100%), poplitcofibular ligament (PFL,100%).arcuale ligament (AL.100%) and fabellofibular ligament (FFL.55%). The posterior part: Posterotibial ligament (PTL.70%) and oblique popliteal ligament (OPL,100%). The intracapusular part: Transverse ligament (TL.80%). posterior meniscofemoral ligament (PMFL,80%) and anterior menicofemoral ligament (AMFL, 7.5%) . 2.The shape, location, origin and insertion,course and adjacency relationships of the individual structures were described. 3.The sizes and angles formed by the long axes of the individual strutures with osseus marks were measured. 4.We divided popliteus muscle into four sections by its course:the muscular section of the popliteus muscle, the musculotendinous junction of the popliteus muscle, the oblique pan of the popliteus tendon and femoral part of the popliteus tendon.Part II: The cross-sectional anatomic study of ULTSObjective: Through the methods of cross-sectional anatomy, to determine the shape, location and adjacency relationships of ULTS on coronal, sagittal and axial plane,and to provide the cross-sectional anatomic evidences for imageology.Materials and Methods: Twelve specimens of cadaver knees were divided into three groups, each of them included four specimens.Coronal, sagittal and axial celloidin sections were made to observe the shape, location and adjacency relationships of individual structures.Results: l.The MPFL, LTL and MOMML (medial oblique meniscomeniscal ligament) can be displayed intactly in axial planes. The ITB, BFM, MCL, FCL, MPTL, PFL and AL can be observed in coronal planes. The MPTL. PFL.FFL and PMFL can be displayed in sagittal planes. 2. the shape, location and adjacency relationships of individual structures were determined.Part III: The study of MRI sequences and orientation of ULTSObjective:Through the study of tibial bone and MRI of the knee joint, to establish the osseus marks adapting for orientation and anatomic measuring, and to determine the methods of orientation to display the long axes of ULTS. Through the study of the MRI sequences, to determine the optimal MRJ sequences for clinical use.Materials and Methods: To establish the osseus marks for orientation of the knee by observing 30 tibial bone specimens. The MR images of 30 normal knees were observed to prove the reliability of the osseus marks, and to determine the methods of orientation of oblique scanning. 30 normal knees were performed MRI of SE T|\VI, SE T:\VI,SE PDI. FE T2’WI. FIR T:\VI, PASTA FSE T2WI, FSTIR, FLAIR and FE-3D. The更多还原