髌下脂肪垫血供特点及在TKA术中的意义
Anatomical features of infrapatellar fat pad vascular network and its significance in TKA
目的 观测髌下脂肪垫血供特点，为TKA术中如何保护其提供应用解剖学基础。 方法 20侧防腐及2侧新鲜成人膝关节标本，用巨微解剖法观测髌下脂肪垫血管网的组成、走行及分布。 结果 髌下脂肪垫血管网外侧由膝下外侧动脉、膝上外侧动脉降支构成，内侧由膝下内侧动脉升支、膝降动脉髌上支的降支、膝降动脉关节支的髌下支构成，各支互相吻合形成网状结构，为"密集血管区"，位于在髌骨内、外侧旁开5 mm范围以内，髌尖下约14 mm，髌韧带后面10 mm区域。此血管网向髌骨下极、髌韧带后部、髌下脂肪垫及其表面的滑膜提供血供。 结论 髌下脂肪垫具有滋养其周围结构的功能，在TKA术中应予保留，若需切除至少应保留"密集血管区"部分。
Objective The purpose of this study is to provide an anatomic evidence of why and how to protect the blood supply of infrapatellar fat pad(IFP) in total knee arthroplasty(TKA). Mothods 20 embalmed adult cadaveric knee and 2 fresh ones underwent micro-anatomy to observe the composition，route and distribution of their IFP vascular network. Result The lateral part of IFP vascular network was formed by inferior lateral genicular artery and the descending branches of superior lateral genicular artery, and the medial part of it was formed by the ascending branches of inferior medial genicular artery and the branches of descending genicular artery. All the arteries and branches connected to each other to build a "concentrated area" which ranged in 5mm to both side of patella, 14mm below the lower end of patella and 10mm behind PL and nourish the lower end of patella, the back of patellar ligament(PL) and the synovial membrane of the whole IFP. Conclusion IFP should be protected in TKA, because of its nourishing function, especially the "concentrated area".
Infrapatellar fat pad / Blood supply / Total knee arthroplasty(TKA) / Applied anatomy
[1] 高士濂．实用解剖图谱.四肢分册（下肢）
[M]．上海：上海科学技术出版社，1985：180-181.
[2] 刘德明.髌下脂体的解剖及其临床意义
[J].江西医药，1995，30（2）：84-85.
[3] Kayler DE, Lyttle D. Surgical interruption of patellar blood supply by total knee arthroplasty［J］. Clin Orthop Relat Res, 1988，（229）:221-227.
[4] Shim S, Leung G. Blood supply of the knee joint: a microangiographic study in children and adults［J］. Clin Orthop Relat Res, 1986，（208）:119-125.
[5] Scapinelli R. Blood supply of the human patella［J］.Bone Joint Surg Br,1967, 49（3）:563-570.
[6] 李义凯,石瑾,钟世镇.髌下脂肪垫解剖学观测及其临床意义
[J].颈腰痛杂志，1999，20（3）：181-182.
[7] Lemon M, Packham I, Narang K,et al. Patellar tendon length after knee arthroplasty with and without preservation of the infrapatellar fat pad［J］．Arthroplasty，2007，22（4）：574-580.
[8] Clayton ML, Thirupathi R. Patellar complications after total condylar arthroplasty［J］.Clin Orthop Relat Res, 1982, (170):152-155.
[9] Gallagher J，Tierney P，Murray P.The infrapatellar fat pad: anatomy and clinical correlations［J］. Knee Surg Sports Traumatol Arthrosc，2005，13(4): 268-272.
[10] Bohnsack M, Wilharm A, Hurschler C, et al.Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee
[J]. Am J Sports Med, 2004, 32(8):1873-1880.
[11] Araoczky SP．Blood supply to the anterior cruclate ligament and supporling strctures
[J]．Ortbop Clin Noth Am，1985, 16（1）：15-28．
[12] 楼新法，陈秀清，陈振光. 带血管蒂髌骨移位修复膝关节面缺损的应用解剖
[J]. 中国临床解剖学杂志，2006，24（2）：136-138.
[13] 符培亮，李晓华，吴字黎.股内侧肌中间入路与内侧髌旁入路在初次全膝关节置换中的对比研究
[J]. 中华创伤骨科杂志, 2007, 9(8):752-755.
京ICP备08002354号-3/
| 〈 |
|
〉 |
