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后交叉韧带损伤

Authors
James MacDonald, MD, MPH, FAAFP, FACSM
Richard Rodenberg, MD
Section Editor
Francis G O'Connor, MD, MPH, FACSM
Deputy Editor
Jonathan Grayzel, MD, FAAEM
Translators
张春礼, 主任医师，教授

引言

后交叉韧带(posterior cruciate ligament, PCL)是限制膝关节处胫骨后移位的主要结构[1-4]。大多数PCL损伤都伴有与多发韧带创伤有关的其他膝关节内紊乱；单纯PCL损伤较少见[5,6]。PCL是在运动中最不容易受伤的膝关节韧带[5-7]。随着不断深入了解PCL的解剖结构及生物力学，人们也认识到了它对膝关节稳定性及功能的重要意义。单纯PCL损伤较少见，因此该损伤的自然病程尚未完全阐明。

本专题将总结PCL损伤的表现、评估、诊断及非手术治疗。其他膝关节损伤以及活跃成人中膝关节不适的总体处理方法将单独讨论。 (参见“前交叉韧带损伤”和“膝关节内侧副韧带损伤”和“膝关节外侧副韧带损伤和相关后外侧角损伤”和“运动员或活跃成人膝关节痛的处理方法”和“成人膝关节痛的一般评估”)

解剖结构与生物力学

PCL是膝关节内最大且最强韧的韧带，起自股骨内侧髁的外侧缘，止于胫骨后部被称为PCL面的凹陷(中心凹)，该凹陷位于胫骨内外侧平台之间(图片 1和图 1和图 2)[1,2,8,9]。鉴于滑膜鞘的覆盖方式，PCL被视为关节内、滑膜外结构[4]。位于滑膜外使单纯PCL损伤时的肿胀有限。PCL与后关节囊相连，因此血供不会在韧带实质内撕裂时发生永久丧失。因此一些PCL损伤可以选用初始手术修复[9]。

PCL在结构上可分为不同但密不可分的两束韧带，即较大的前外侧束(anterolateral, AL)和较小的后内侧束(posteromedial, PM)。这两束韧带在功能上有差异，它们会随膝关节的屈曲程度而表现出不同的紧张和松弛模式[1,2,8,9]。PCL与板股韧带协同工作，共同组成PCL复合体。半月板股韧带起自外侧半月板后角，止于股骨内侧髁，既可位于PCL前方(此时称Humphrey韧带)，也可位于PCL后方(此时称Wrisberg韧带)。固定外侧半月板的同时，这些韧带也发挥着胫骨后移位次级限制结构的作用[2,4,8,9]。

PCL复合体的主要作用是限制胫骨相对于股骨后移位，同时也是对抗外旋的次级结构[2,8]。此外，PCL能够防止伸展的膝关节受到内翻和外翻应力。膝关节屈曲时，PCL会为稳定膝关节后部做出更大贡献。膝关节屈曲30°-90°时，95%的后方稳定性都是由PCL提供[8]。PCL的两束韧带根据各自在不同膝关节屈曲度下的纤维走向来稳定关节[1,2,8]。本质上来说，它们在膝关节屈伸过程中呈交替紧张松弛模式：AL束在伸膝时松弛，屈曲时逐渐紧张；PM束在伸膝时紧张而屈曲时变得越来越松弛[1,8]。因此可能应将PCL看作一个复合结构，其具有在不同膝关节屈曲度下出现不同长度和不同张力的一系列连续纤维[8]。

                                   

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-08.
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