目的 介绍发现胫骨髁间隆突孔的研究过程,并描述其结构,初步探索胫骨髁间隆突孔造成胫骨近端侵袭性肿瘤隐匿及突入行为特定的结构性原因.方法 采用回顾性研究方法,在影像中心数据库中随机纳入2017年5月至2017年11月200例患者的CT扫描及三维重建资料,男115例,女85例,年龄18～90岁,平均(49.2±7.3)岁.观察胫骨髁间隆突孔是否存在,并行影像学定位、测量.通过50例膝关节置换截取的胫骨平台、5例车祸或肿瘤截肢新鲜标本,实物证明胫骨髁间隆突孔存在,并对其具体位置、小孔周围结构、小孔近端覆盖情况、小孔内容物、孔口、孔壁及孔底组织进行研究分析,同时进行病理学染色浸润观察.结果 200例患者全部存在胫骨髁间隆突孔,该孔位于髁间隆突中部凹陷处、前后叉韧带止点之间.孔呈圆形,直径(1.6±0.3)mm,深度(9.1±2.5)mm.106例(106/200,53％)可观察到主孔周围(半径≤7mm)存在1～3个副孔,直径及深度均小于主孔.CT值示孔口(472.5±30.1)HU＞孔壁(312.3±22.5)HU＞孔底(202.4±17.3)HU＞孔内(118.3±10.4)HU＞孔口覆盖物(75.0±11.1)HU.孔口与关节腔只有厚度约1 mm滑膜组织间隔,孔口周围为软骨组织,孔壁及底均为松质骨,内容物为较致密结缔组织,与孔壁并不完全帖附、存在缝隙.孔内滴入亚甲蓝示周围松质骨易浸润,术前造影示孔周围及孔内阻挡能力薄弱.结论 胫骨髁间隆突孔是人体固有结构,覆盖薄弱,容易造成肿瘤隐匿而复发,肿瘤可能经此孔在胫骨近端和关节腔之间双向突入.%Objective To introduce the tibial intercondylar eminence hole (TIEH) and study its structure.Explore the connection between TIEH and the pathway how proximal tibial aggressive tumor break into the bony structure from articular cavity.Methods This retrospective study included 200 patient's CT 3-dimensional reconstruction materials from May 2017 to November 2017 in Qilu hospital randomly.There were 115 males and 85 females,the average age was 49 years (ranged from 12 to 90 years).To observe the existence of TIEH and identify its location and measurement with imaging techniques.According to 50 tibial plateau specimen after TKA and 5 specimen after car accident or amputation due to tumor,physical proof the existence of TIEH.The specific location,peripheral structure,coverage,content of TIEH as well as its top,walls and bottom were researched and analysed.Pathological staining was used and 1 cases undertook preoperation contrast agent observation.1 cases of typical cases were reviewed.Results TIEH was ubiquity according to all of the 200 cases.TIEH was located on the depression of tibial plateau,between the attachments of ACL and PCL.The hole was round type,and the diameter was 1.6±0.3 mm,the depth was 9.1±2.1 mm.1-3 Paraforamen (semidiamete≤7 mm) were found around the main TIEH in 53％ patients (106/200),the diameter and depth was less than the main hole.The CT value showed the orifice (472.5±30.1 HU) ＞ the pore wall (312.3±22.5 HU) ＞ the pore bottom (202.4±17.3 HU) ＞ the pore (118.3±10.4 HU) ＞ the orifice covering (75.0±11.1 HU).The synovial tissue septum was only 1 mm between the top of hole and the articular cavity.The top of TIEH was surrounded by articular cartilage,the walls and bottom were spongy bone,the content was dense connective tissue that didn't attach to the walls tightly.The peripheral spongy bone was easy to infiltrate by methylene blue.Preoperation radiography showed that TIEH had poor barrier function.Conclusion Tibial intercondylar eminence hole is an intrinsic structure of the human body.The coverage is weak,and it is easy to cause the tumor to hide and recur.The tumor may pass through this hole and bidirectionally enter between the proximal humerus and the joint cavity.
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