膝關節后縱隔解剖特點及其在關節鏡手術中的應用_《中國修復重建外科雜志》

作者：

孫金鵬 , 熊依林 , 雷光華

中南大學湘雅醫院骨科（長沙，410008）;

關鍵詞：

膝關節關節鏡手術后縱隔解剖結構

DOI：

10.7507/1002-1892.20130050

視頻：

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目的總結膝關節后縱隔解剖特點及其在關節鏡手術中，尤其是跨后縱隔通路建立中的應用。方法查閱近年國內外有關膝關節后縱隔及膝關節鏡的文獻，并進行歸納分析。結果后縱隔上部血管、神經較豐富，在脛骨平臺水平與腘動脈緊鄰；將膝關節后室分為較小的外室和較大的內室。膝關節鏡下建立跨后縱隔通道時應屈膝90°，方向由外向內，從后縱隔中間靠下部穿過較安全。結論跨后縱隔通道使膝關節鏡應用范圍大大擴展，但通道建立方法并不統一，只有綜合考慮后縱隔解剖學特點，才能減少手術并發癥。

引用本文： 孫金鵬,熊依林,雷光華. 膝關節后縱隔解剖特點及其在關節鏡手術中的應用. 中國修復重建外科雜志, 2013, 27(2): 233-235. doi: 10.7507/1002-1892.20130050 復制

1.	21 Tawes RJ Jr, Etheredge SN, Webb RL, et al. Popliteal artery injury complicating arthroscopic menisectomy. Am J Surg, 1988, 156(2): 136-138. 22 Beck DE, Robison JG, Hallett JW Jr. Popliteal artery pseudoaneurysm following arthroscopy. J Trauma, 1986, 26(1): 87-89. 23 Pace JL, Wahl CJ. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy, 2010, 26(5): 637-642. 24 Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy, 2000, 16(8): 796-804. 25 Cosgarea AJ, Kramer DE, Bahk MS, et al. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg, 2006, 19(3): 181-185. 26 Ramos LA, de Carvalho RT, Cohen M, et al. Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy, 2008, 24(12): 1367-1372. 27 Smith PN, Gelinas J, Kennedy K, et al. Popliteal vessels in knee surgery. A magnetic resonance imaging study. Clin Orthop Relat Res, 1999, (367): 158-164.
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21.	Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy, 2000, 16(7): 774-779.
22.	Louisia S, Charrois O, Beaufils P. Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy, 2003, 19(3): 321-325.
23.	Ahn JH, Lee YS, Lee DH, et al. Intraarticular fibroma of the posterior compartment in the knee. A case report. Knee, 2008, 15(2): 155-158.
24.	Lakdawala A, El-Zebdeh M, Ireland J. Excision of a ganglion cyst from within the posterior septum of the knee—an arthroscopic technique. Knee, 2005, 12(3): 245-247.
25.	Ramos LA, Astur D, Novaretti JV, et al. An anatomic study of the posterior septum of the knee. Arthroscopy, 2012, 28(1): 100-104.
26.	Kramer DE, Bahk MS, Brett M, et al. Posterior knee arthroscopy: anatomy, technique, application. J Bone Joint Surg (Am), 2006, 88 Suppl 4: 110-121.
27.	Kim SJ, Song HT, Moon HK, et al. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc, 2011, 19(8): 1320-1325.
28.	羅浩, 余家闊. 膝關節后縱隔與后交叉韌帶下止點的解剖關系及臨床意義. 解剖學報, 2010, 41(4): 616-619.
29.	Kim SJ, Jung KA, Kwun JD, et al. Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy, 2006, 22(4): 461. e1-4.
30.	Kyung BS, Lee SH, Han SB, et al. Arthroscopic treatment of synovial chondromatosis at the knee posterior septum using a trans-septal approach: report of two cases. Knee, 2012, 19(5): 732-735.
31.	Ogilvie-Harris DJ, Biggs DJ, Mackay M, et al. Posterior portals for arthroscopic surgery of the knee. Arthroscopy, 1994, 10(6): 608-613.
32.	Kim JM. Direct posterior-posterior triangulation of the knee joint. Arthroscopy, 1997, 13(2): 262-264.
33.	Yoo JH, Kim EH, Min KD, et al. Arthroscopic excision of the ganglion in the posterior septum by posterior trans-septal portal: report of two cases. Arch Orthop Trauma Surg, 2009, 129(8): 1047-1051.
34.	Furie E, Yerys P, Cutcliffe D, et al. Risk factors for arthroscopic popliteal artery laceration. Arthroscopy, 1995, 11(3): 324-327.
35.	Potter D, Morris-Jones W. Popliteal artery injury complicating arthroscopic meniscectomy. Arthroscopy, 1995, 11(6): 723-726.
36.	Bernard M, Grothues-Spork M, Georgoulis A, et al. Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 14-18.
37.	Ritt MJ, Te Slaa R, Koning J, et al. Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res, 1993, (295): 198-200.
38.	Jimenez F, Utrilla A, Cuesta C, et al. Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma, 1988, 28(9): 1404-1405.
39.	Casscells SW. Injury to the popliteal artery as a complication of arthroscopic surgery. A report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 150.

1. 21 Tawes RJ Jr, Etheredge SN, Webb RL, et al. Popliteal artery injury complicating arthroscopic menisectomy. Am J Surg, 1988, 156(2): 136-138. 22 Beck DE, Robison JG, Hallett JW Jr. Popliteal artery pseudoaneurysm following arthroscopy. J Trauma, 1986, 26(1): 87-89. 23 Pace JL, Wahl CJ. Arthroscopy of the posterior knee compartments: neurovascular anatomic relationships during arthroscopic transverse capsulotomy. Arthroscopy, 2010, 26(5): 637-642. 24 Matava MJ, Sethi NS, Totty WG. Proximity of the posterior cruciate ligament insertion to the popliteal artery as a function of the knee flexion angle: implications for posterior cruciate ligament reconstruction. Arthroscopy, 2000, 16(8): 796-804. 25 Cosgarea AJ, Kramer DE, Bahk MS, et al. Proximity of the popliteal artery to the PCL during simulated knee arthroscopy: implications for establishing the posterior trans-septal portal. J Knee Surg, 2006, 19(3): 181-185. 26 Ramos LA, de Carvalho RT, Cohen M, et al. Anatomic relation between the posterior cruciate ligament and the joint capsule. Arthroscopy, 2008, 24(12): 1367-1372. 27 Smith PN, Gelinas J, Kennedy K, et al. Popliteal vessels in knee surgery. A magnetic resonance imaging study. Clin Orthop Relat Res, 1999, (367): 158-164.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20. 桂鑒超, 王黎明, 張昊偉, 等. 跨膝關節后縱隔入路的建立及臨床應用. 中華外科雜志, 2006, 44(16): 1106-1110.
21. Ahn JH, Ha CW. Posterior trans-septal portal for arthroscopic surgery of the knee joint. Arthroscopy, 2000, 16(7): 774-779.
22. Louisia S, Charrois O, Beaufils P. Posterior “back and forth” approach in arthroscopic surgery on the posterior knee compartments. Arthroscopy, 2003, 19(3): 321-325.
23. Ahn JH, Lee YS, Lee DH, et al. Intraarticular fibroma of the posterior compartment in the knee. A case report. Knee, 2008, 15(2): 155-158.
24. Lakdawala A, El-Zebdeh M, Ireland J. Excision of a ganglion cyst from within the posterior septum of the knee—an arthroscopic technique. Knee, 2005, 12(3): 245-247.
25. Ramos LA, Astur D, Novaretti JV, et al. An anatomic study of the posterior septum of the knee. Arthroscopy, 2012, 28(1): 100-104.
26. Kramer DE, Bahk MS, Brett M, et al. Posterior knee arthroscopy: anatomy, technique, application. J Bone Joint Surg (Am), 2006, 88 Suppl 4: 110-121.
27. Kim SJ, Song HT, Moon HK, et al. The safe establishment of a transseptal portal in the posterior knee. Knee Surg Sports Traumatol Arthrosc, 2011, 19(8): 1320-1325.
28. 羅浩, 余家闊. 膝關節后縱隔與后交叉韌帶下止點的解剖關系及臨床意義. 解剖學報, 2010, 41(4): 616-619.
29. Kim SJ, Jung KA, Kwun JD, et al. Arthroscopic synovectomy of the knee joint in rheumatoid arthritis: surgical steps for complete synovectomy. Arthroscopy, 2006, 22(4): 461. e1-4.
30. Kyung BS, Lee SH, Han SB, et al. Arthroscopic treatment of synovial chondromatosis at the knee posterior septum using a trans-septal approach: report of two cases. Knee, 2012, 19(5): 732-735.
31. Ogilvie-Harris DJ, Biggs DJ, Mackay M, et al. Posterior portals for arthroscopic surgery of the knee. Arthroscopy, 1994, 10(6): 608-613.
32. Kim JM. Direct posterior-posterior triangulation of the knee joint. Arthroscopy, 1997, 13(2): 262-264.
33. Yoo JH, Kim EH, Min KD, et al. Arthroscopic excision of the ganglion in the posterior septum by posterior trans-septal portal: report of two cases. Arch Orthop Trauma Surg, 2009, 129(8): 1047-1051.
34. Furie E, Yerys P, Cutcliffe D, et al. Risk factors for arthroscopic popliteal artery laceration. Arthroscopy, 1995, 11(3): 324-327.
35. Potter D, Morris-Jones W. Popliteal artery injury complicating arthroscopic meniscectomy. Arthroscopy, 1995, 11(6): 723-726.
36. Bernard M, Grothues-Spork M, Georgoulis A, et al. Neural and vascular complications of arthroscopic meniscal surgery. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 14-18.
37. Ritt MJ, Te Slaa R, Koning J, et al. Popliteal pseudoaneurysm after arthroscopic meniscectomy. A report of two cases. Clin Orthop Relat Res, 1993, (295): 198-200.
38. Jimenez F, Utrilla A, Cuesta C, et al. Popliteal artery and venous aneurysm as a complication of arthroscopic meniscectomy. J Trauma, 1988, 28(9): 1404-1405.
39. Casscells SW. Injury to the popliteal artery as a complication of arthroscopic surgery. A report of two cases. J Bone Joint Surg (Am), 1988, 70(1): 150.

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膝關節后縱隔解剖特點及其在關節鏡手術中的應用

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膝關節后縱隔解剖特點及其在關節鏡手術中的應用

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