摘要
目的 比较前交叉韧带（ACL）单束重建术中股骨钩定位法与钻头直接定位法确定股骨隧道的特点,并对其应用CT三维模型进行分析。方法 回顾性分析自2011-02—2013-10关节镜下ACL单束重建术86例,应用股骨定位钩定位股骨隧道34例（股骨钩定位组）,应用钻头直接定位股骨隧道52例（钻头直接定位组）,术后行膝关节三维CT扫描并结合四分法、坐标轴法比较2组隧道长度以及隧道的位置。结果 钻头直接定位组隧道长度34-41（37.0±2.1）mm,股骨钩定位组隧道长度38-48（42.0±3.5）mm。在四分法4×4网格中,股骨钩定位组有31例股骨隧道位置落于1a中,3例落于2a中;钻头直接定位组有49例股骨隧道位置落于2b中,2例落于1b中,1例落于2a中。在t线上,股骨钩定位组股骨隧道位置与前内侧束（AM）位置差异无统计学意义（P=0.295）,与后外侧束（PL）位置差异有统计学意义（P〈0.001）;在h线上,股骨钩定位组股骨隧道位置与AM、PL位置差异均有统计学意义（P〈0.001）。在t线和h线上,钻头直接定位组股骨隧道位置与AM、PL位置差异均无统计学意义（P〉0.025）。结论 股骨钩定位法股骨隧道位置偏高、偏后,但长度较长;钻头直接定位法股骨隧道位置更接近解剖止点,但长度偏短。ACL单束重建术中股骨隧道定位方法可根据情况灵活选择。
Objective To compare the characteristics between two methods of the femoral tunnel positioning using the endo- femoral guide（EFG） technique and the bit locating directly（BLD） technique after anterior cruciate ligament（ACL） single bundle reconstruction, and analyze with 3-dimensional computed tomography （3D CT）. Methods The retrospective studies were performed on 86 knees that had undergone single-bundle reconstruction of the ACL, including EFG in 34 cases, and BLD in 52 cases. Three-dimensional computed tomography models were aligned into an anatomical coordinate system. Femoral tunnel aperture centers were measured in anatomic posterior-anterior and proximal-to--distal directions with the quadrant method. These measurements were compared with reference data on anatomical tunnel positions and length. Results The mean tunnel length was 34-41 （37.0±2.1）mm by BLD and 38-48 （42.0±3.5）mm by EFG. According to the 4×4 mesh, the EFG was positioned at la in 31 cases, 2a in 3 cases, whereas BLD was positioned at 2b in 49 cases, 2a in 1 cases, lb in 2 cases. According to the t line （parallel to the Blumensaat line）, no statistical significance were found between the position of femoral tunnels drilled by EFG and the anatomy position of the AM bundles of the ACL （P=0.295） but the position of the PL bundles of the ACL（P 〈0.001）. According to the h line （perpendicular to the Blumensaat line）, at the mean while, the EFG group had significant differencesin beth AM and PL position （P 〈0.001）. On the other hand, the position of femoral tunnels drilled by BLD had no significant difference in both AM and PL position （P 〉0.025）. Conclusion EFG results in anterior （high） tunnel placement on the femur and posterior tunnel placement are with a longer tunnel than the other. BLD is performed closer to the anatomical tunnel positions, but its length of tunnel is shorter.
出处
《中国骨与关节损伤杂志》
2015年第8期804-807,共4页
Chinese Journal of Bone and Joint Injury
基金
辽宁省自然科学基金(2013020175)
关键词
前交叉韧带重建术
股骨隧道
股骨钩定位法
钻头直接定位法
CT三维重建
Anterior cruciate ligament reconstruction
Femoral tunnel
Endo-femoral guide
Bit locating directly
3- dimensional computed tomography
