Petersen W, Stein V, Tillmann B
Lubinus Klinik, Klinik für Chirurgie und Orthopädie, Kiel.
Unfallchirurg. 1999 Jul;102(7):543-7. doi: 10.1007/s001130050448.
Degenerative changes have been considered to be a cause for spontaneous quadriceps tendon rupture. Aim of this study is to investigate the microvasculature of the quadriceps tendon by injection techniques and immunohistochemical methods (antibodies against laminin) with regard to the pathogenesis of tendon degeneration. The blood supply of the quadriceps tendon arises from descending branches of the lateral circumflex femoral artery, by branches of the descending geniculate artery and by branches of the medial and lateral superior geniculate arteries. Blood vessels penetrate the tendon from the surrounding connective tissue and anastomose with a longitudinally orientated intraligamentous network. Compared to the surrounding synovial layer, the amount of vessels in the tendon substance is greatly reduced. The distribution of blood vessels within the quadriceps tendon is not homogenous. The anterior or superficial part of the tendon has a complete vascular network that extends from the musculo-tendinous junction to the patella. Within the deep portion of the quadriceps tendon there is an oval shaped avascular area which measures app. 30 mm in length and app. 15 mm in width. Within this area the immunohistochemical proof of laminin is negative. An explanation for the absence of blood vessels may be compressive stress caused by the patellar groove which serves as hypomochlion for the quadriceps tendon when the knee is flexed. The occurrence of an avascular zone within the deep layer of the tendon that is directed to the joint cavity may explain the frequency of degenerative changes in this region.
退行性改变被认为是股四头肌肌腱自发性断裂的一个原因。本研究的目的是通过注射技术和免疫组织化学方法(抗层粘连蛋白抗体)研究股四头肌肌腱的微血管系统,以探讨肌腱退变的发病机制。股四头肌肌腱的血液供应来自旋股外侧动脉的降支、膝降动脉的分支以及膝上内侧和外侧动脉的分支。血管从周围结缔组织穿透肌腱,并与纵向排列的韧带内网络吻合。与周围滑膜层相比,肌腱实质内的血管数量大大减少。股四头肌肌腱内血管的分布不均匀。肌腱的前部或浅表部分有一个完整的血管网络,从肌肉-肌腱连接处延伸至髌骨。在股四头肌肌腱的深部有一个椭圆形的无血管区域,长约30毫米,宽约15毫米。在这个区域,层粘连蛋白的免疫组织化学证据为阴性。血管缺失的一个解释可能是髌槽引起的压缩应力,当膝关节屈曲时,髌槽作为股四头肌肌腱的支点。肌腱深层朝向关节腔的无血管区的出现可以解释该区域退变改变的发生率。