摘要
目的探讨前交义韧带(ACL)重建术中股骨和胫骨隧道定位变化对移植物等距特性的影响。方法选用10具正常新鲜冷冻尸体膝关节标本,在股骨取3个定位点,第一个定位点位于右膝11点(左膝1点)过顶点前方5～6 mm处,作为前束点；第二点位于前束点前5 mm处,作为误差点；第三点位于屈膝90°时,ACL附着区长轴与经股骨-胫骨接触点的垂直线的交点,作为后束点。在ACL胫骨附着区的前后径上取3个定位点,一个位于原ACL附着区中心,称为中心点；一个位于中心点后5 mm处,称为5 mm后点；一个位于中心点后10 mm处,称为10 mm后点。模拟ACL重建步骤,经各个股骨和胫骨定位点分别钻直径为2 mm的骨隧道,通过测量钢丝和等距测量仪来检测膝关节屈曲过程中各个股骨隧道内口相对于各个胫骨隧道内口的距离变化。结果相对于某一个固定的股骨隧道内口,胫骨隧道内口的前后移位变化对移植物等距特性的影响差异无显著性意义(P＞0．05)；相对于某一个固定的胫骨隧道内口,股骨隧道内口位置的变化对移植物等距特性的影响差异有极显著性意义(P＜0．01)。从膝关节完全伸直到极度屈曲的过程中,如果股骨隧道内口选择在前束点,则两内口间移植物长度变化在生理等距范围内；若选择在误差点,则两内口间移植物长度变化表现为超出生理等距范围的延长；若选择在后束点,则两内口间移植物长度变化表现为超出生理等距范围的短缩。结论ACL重建时,胫骨隧道内口在ACL附着区中心与棘间区后缘之间的前后移位对移植物等距特性无明显影响,股骨隧道内口的移位对移植物的等距特性有明显影响。
Objective To explore the isometricity of grafts in ACL （anterior cruciate-ligament） reconstruction under bone tunnel shifting condition. Methods Knee specimens from ten fresh frozen cadavers were used. Femoral tunnels of 2 mm were drilled at three points on the medial aspect of the lateral condyle. The first was ＂anterior bundle point＂ （located at the 11 o＇clock position in the right knee and 1 o＇clock position in the left knee）. The second was ＂error point＂ （located at the place 5 mm anterior and distal to the ＂anterior bundle point＂） . The third was ＂posterior bundle point＂ （located at the crossing point of the long axis of the ACL attachment and a vertical line drawn across the femoral-tibial contact point with the knee flexed at 90°） . Moreover, tibial tunnels of 2 mm were drilled at three points on the tibial plateau. The first was ＂central point＂ （located at the center of original insertion of ACL）. The second was ＂5 mm posterior point＂, located at the place 5 mm posterior to the ＂central point＂. The third was ＂10 mm posterior point＂, located at the place 10 mm posterior to the ＂central point＂. Changes in distance between each pair of tibial and femoral tunnels were measured during passive knee flexion-extension. Results The anterior-posterior shifting of the tibial tunnel was found to have little influence （ P 〉 0. 05 ） on the isometricity after the femoral tunnel had been chosen. However, the shifting of the femoral tunnel was found to have significant influence（ P 〈 0. 01 ） on the isometricity. Changes in distance related to the ＂anterior bundle point＂ led to lengths within the physiologic isometric range. Changes in distance related to the ＂error point＂ led to lengthening （ligament stretching） beyond the physiologic isometric range. Changes in distance related to the ＂posterior bundle point＂ led to shortening （ligment relaxing） beyond the physiologic isometric range. Conclusion Anterior-posterior shifting of the
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第7期663-667,共5页
Chinese Journal of Orthopaedic Trauma
关键词
前交叉韧带
骨隧道
重建
等距性
Anterior cruciate ligament （ACL）
Bone tunnel
Reconstruction
Isometricity
