Boon J M, Van Wyk M J, Jordaan D
Department of Anatomy, Section of Clinical Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, 0001 Pretoria, South Africa.
Surg Radiol Anat. 2004 Jun;26(3):167-71. doi: 10.1007/s00276-003-0213-z. Epub 2003 Nov 26.
Anterior cruciate ligament (ACL) reconstruction with autogenous semitendinosus and gracilis tendons has become a common surgical procedure. Lower leg paresthesia following injury to the infrapatellar nerve during harvesting of the tendons has been well documented. Few authors have described the position of the infrapatellar nerve on a flexed knee, which is the position used during ACL reconstruction. The purpose of this study was to determine a safe area and angle where an incision could be made for harvesting of the semitendinosus and gracilis tendons, with the knee in flexion. Twenty right cadaver knees and 20 left knees were dissected. Landmarks on the knee were identified, from where the distances to the nerves (infrapatellar and saphenous) were measured with a vernier caliper. A safe area on the right knee was determined to be on the tibial tuberosity plane between 3.7 and 5.5 cm with a safe angle of incision of 51.6 degrees. A safe area on the left knee was determined to be on the tibial tuberosity plane between 3.6 and 4.9 cm with a safe angle of incision of 52.5 degrees. The results may assist orthopedic surgeons performing ACL reconstruction with semitendinosus and gracilis tendons to avoid cutaneous nerve damage and, therefore, patient discomfort.
采用自体半腱肌和股薄肌腱重建前交叉韧带（ACL）已成为一种常见的外科手术。在肌腱采集过程中髌下神经损伤后出现小腿感觉异常已有充分记录。很少有作者描述过髌下神经在屈膝时的位置，而屈膝位是ACL重建时所采用的体位。本研究的目的是确定在屈膝状态下采集半腱肌和股薄肌腱时可进行切口的安全区域和角度。对20个右膝关节和20个左膝关节进行了解剖。确定了膝关节上的标志点，并用游标卡尺测量从这些标志点到神经（髌下神经和隐神经）的距离。右膝关节的安全区域确定为在胫骨结节平面上3.7至5.5厘米处，安全切口角度为51.6度。左膝关节的安全区域确定为在胫骨结节平面上3.6至4.9厘米处，安全切口角度为52.5度。这些结果可能有助于进行半腱肌和股薄肌腱ACL重建的骨科医生避免皮神经损伤，从而避免患者不适。
