Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee
Clinical Anatomy of the Quadriceps Femoris and Extensor Apparatus of the Knee
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DOI：
10.1007/s11999-009-1052-y
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发表时间：
2009-12-01
影响因子：
4.2
通讯作者：
Hirsch, Bruce Elliot
中科院分区：
文献类型：
--
作者：
Waligora, Andrew C.;Johanson, Norman A.;Hirsch, Bruce Elliot
大多数对膝关节伸肌机制的描述都没有考虑到它的复杂性和可变性。股四头肌插入髌骨是通过一个三层排列的共同肌腱：股直肌（RF）最浅，股内侧肌（VM）和外侧肌（VL）在中间层，股中间肌（VI）最深。我们解剖了17具尸体的20条肢体，以提供对膝关节前部组成部分（肌腱、髌骨支持带和髌股韧带）的更详细描述。20个标本中只有3个表现出典型的四头肌模式。其余的具有双层和甚至更复杂的三层和四层纤维排列。在60%的标本中，我们发现股外侧肌（VLO）的斜头，通过一层脂肪或筋膜与纵头分开。然而，我们没有发现明显的斜头股内侧肌（VMO）在任何标本。内侧髌股韧带（MPFL）比外侧（LPFL）更常见，支持其作为髌骨主要被动内侧稳定器的建议作用。由于股四头肌群在髌股关节功能中起着直接作用，因此对其高度可变的解剖结构的临床应用进行研究对于关节功能障碍和TKA失败可能是值得的。
Most descriptions of the extensor mechanism of the knee do not take into account its complexity and variability. The quadriceps femoris insertion into the patella is said to be through a common tendon with a three-layered arrangement: rectus femoris (RF) most superficially, vastus medialis (VM) and lateralis (VL) in the intermediate layer, and vastus intermedius (VI) most deeply. We dissected 20 limbs from 17 cadavers to provide a more detailed description of the anterior components of the knee: the tendon, the patellar retinacula, and the patellofemoral ligaments. Only three of the 20 specimens exhibited the typically described quadriceps pattern. The remainder had bilaminar and even more complex trilaminar and tetralaminar fiber arrangements. We found an oblique head of the vastus lateralis (VLO), separated from the longitudinal head by a layer of fat or fascia, in 60% of the specimens. However, we found no distinct oblique head of the vastus medialis (VMO) in any specimen. The medial patellofemoral ligament (MPFL) was more common than the lateral (LPFL), supporting its suggested role as the principal passive medial stabilizer of the patella. Because the quadriceps muscle group plays a direct role in patellofemoral joint function, investigation into the clinical applications of its highly variable anatomy may be worthwhile with respect to joint dysfunction and failures of TKAs.