New insight in the architecture of the quadriceps tendon.
New insight in the architecture of the quadriceps tendon.
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DOI：
10.1186/s40634-016-0068-y
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发表时间：
2016-12
影响因子：
1.8
通讯作者：
Kuster MS
中科院分区：
文献类型：
--
作者：
Grob K;Manestar M;Filgueira L;Ackland T;Gilbey H;Kuster MS
关于股四头肌肌腱结构的已发表数据多种多样。股四头肌群的解剖显示，除了股直肌、股外侧肌、股中间肌和股内侧肌之外，第五个肌肉成分-称为股中间肌张肌一致地融合到股四头肌肌腱中。可以假设，膝关节伸肌装置的所有这些元件也必须在股四头肌腱中表示。本研究调查了多层股四头肌肌腱，特别强调股四头肌群的所有组成部分，包括新发现的股中间肌张肌。解剖10具尸体下肢。确定膝关节伸肌装置的所有肌腹，并向远端追踪，直到它们合并到股四头肌腱。从起点到止点，研究了每块肌肉不同腱膜层之间的联系。每一层的融合点都有标记。测量其到髌骨的距离和融合点之间的距离。股四头肌群的六个元件形成股四头肌肌腱的三层结构。中间层可以进一步细分。股四头肌腱的元素是1。股中间肌外侧腱膜，2.深，3。股中间肌浅内侧腱膜，4.股外侧肌，5.股中间张肌和6.股直肌即使纤维方向不同-这些元件在髌骨近端的一定距离处彼此连接。所有元件在髌骨近端13 - 90 mm的区域上融合。股中间肌外侧部是股四头肌腱的最深层。股中间肌内侧腱膜的浅层和深层分别与股中间肌和股外侧肌腱膜在髌骨上方56 mm（范围30 ~ 90 mm）和33 mm（范围13 ~ 53 mm）处融合。他们一起构建了股四头肌腱的两层中间层。股直肌肌腱形成浅层。股内侧肌插入股四头肌肌腱的所有层。外侧肌成分的纤维朝向内侧，内侧肌成分的纤维朝向股骨外侧髁。三层股四头肌腱由六个元素组成。这些是1.股中间肌外侧腱膜，2.深，3。股中间肌浅内侧腱膜，4.股外侧肌，5.股中间张肌和6.股直肌伸肌装置的这些元件在髌骨近端以复杂的洋葱状结构彼此连接。它的两层中间层显示了可变的融合点。股内侧肌有助于股四头肌肌腱，其内侧插入股四头肌肌腱的所有层。
Published data regarding the structure of the quadriceps tendon are diverse. Dissection of the quadriceps muscle group revealed that beside the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis a fifth muscle component– named the tensor vastus intermedius consistently fused into quadriceps tendon. It can be hypothesized that all these elements of the extensor apparatus of the knee joint must also be represented in the quadriceps tendon. This study investigated the multi-layered quadriceps tendon with special emphasis on all components of the quadriceps muscle group including the newly discovered tensor vastus intermedius. Ten cadaveric lower limbs were dissected. All muscle bellies of the extensor apparatus of the knee joint were identified and traced distally until they merged into the quadriceps tendon. Connections between the different aponeurotic layers of each muscle were studied from origin to insertion. The fusing points of each layer were marked. Their distance to the patella and the distances between the fusing points were measured. Six elements of the quadriceps muscle group form a tri-laminar structure of the quadriceps tendon. The intermediate layer could be further sub-divided. The elements of the quadriceps tendon are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. Even with differences in fiber direction – these elements join each other a certain distance proximal to the patella. All elements were fused over a region measuring 13 to 90 mm proximal to the patella. Lateral parts of the vastus intermedius formed the deepest layer of the quadriceps tendon. The superficial and deep layer of the medial vastus intermedius aponeurosis fused 56 mm (range, 30 to 90 mm) and 33 mm (range, 13 to 53 mm) above the patella with the aponeurosis of the tensor vastus intermedius and vastus lateralis respectively. Together they built the two-layered intermediate layer of the quadriceps tendon. The tendon of the rectus femoris forms the superficial layer. The vastus medialis inserts medially in all layers of the quadriceps tendon. Fibers of the lateral muscle components were oriented towards the medial, and fibers of the medial muscle components were oriented towards the lateral femoral condyle. The three-layered quadriceps tendon is formed by six elements. These are 1. lateral aponeurosis of the vastus intermedius, 2. deep and 3. superficial medial aponeurosis of the vastus intermedius, 4. vastus lateralis, 5. tensor vastus intermedius and 6. rectus femoris. These elements of the extensor apparatus join each other proximal to the patella in a complex onion-like architecture. Its two-layered intermediate layer shows variable fusions points. The vastus medialis contributes to the quadriceps tendon with its medial insertion into all layers of the quadriceps tendon.