Liu Jing, Xiu Zhong-Biao, Lin Qiao-Xuan, Lu Li-Ming, Guo Ze-Xing, Gong Yu-Rong
First Department of Orthopedics, People's Hospital Affiliated to Fujian University of TCM, Fuzhou 350004, China.
First Department of Orthopedics, People's Hospital Affiliated to Fujian University of TCM, Fuzhou 350004, China; Key Laboratory of Orthopedics and Sports Rehabilitation of TCM of Ministry of Education; Fujian Institute of Orthopedics.
Zhongguo Zhen Jiu. 2021 Aug 12;41(8):892-6. doi: 10.13703/j.0255-2930.20200713-k0002.
To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.
Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.
The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.
The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.
探讨膝骨关节炎（KOA）常见肌腱病变的超声解剖特点及针刀进针途径，为基于经筋理论沿肌腱病变精准针刀松解KOA提供参考。
选取60例单膝KOA患者。采用高频肌肉骨骼超声在“鹤顶刺”“髌外下”“髌内下”及“阴陵上”解剖位置采集超声图像，在超声图像上标记解剖层次。对比分析病变的解剖层次及超声特征，并测量针刀模拟进针途径的相关数据。
“鹤顶刺”病变主要位于股四头肌肌腱与髌骨附着处及髌上囊；“髌外下”及“髌内下”病变主要位于髌外侧支持带及髌内侧支持带与髌骨及髌下脂肪垫附着处；“阴陵上”病变主要位于鹅足肌腱与胫骨内侧髁附着处及鹅足囊。以“鹤顶刺”为例，针刀进针点位于髌骨上方1 cm时，可松解股四头肌肌腱与髌骨附着处，针刀平均深度为（3.60±0.10）cm，针体垂直于皮肤；松解髌上囊时针刀平均深度为（2.35±0.17）cm，针体向头侧呈45°。
肌肉骨骼超声能清晰显示KOA常见肌腱病变的局部详细解剖层次、超声特征及解剖位置，可提高非直视下沿肌腱病变针刀操作的准确性，对针刀医学规范化及标准化操作具有重要参考价值。
