不同定位方法对单束前交叉韧带重建术中股骨隧道的影响
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摘要
目的比较两种股骨隧道定位方法对前交叉韧带重建术中股骨隧道的影响。方法收集采用自体腘绳肌行单束前交叉韧带重建术的80例患者为观察对象,随机分为经胫骨定位股骨隧道组(TT组)和经前内侧定位股骨隧道组(AM组),每组40例。记录术中股骨隧道的长度,测量并计算术后X线上股骨隧道在冠状位、矢状位的角度和股骨止点距Blumensaat线的相对位置,并行统计学分析。结果 TT组股骨隧道长度为(47. 13±6. 78) mm,明显长于AM组的(42. 10±4. 65) mm(P <0. 05)。TT组和AM组股骨隧道在冠状位角度分别为(53. 33±6. 68)°、(45. 25±4. 93)°,在矢状位的角度分别为(44. 45±8. 59)°、(37. 13±6. 52)°,两组间比较,差异有统计学意义(P <0. 05)。TT组和AM组股骨止点的相对位置分别为(61. 22±6. 09)%、(65. 01±4. 83)%,两组间比较,差异有统计学意义(P <0. 05)。结论与TT技术相比,AM技术建立的股骨隧道更短,角度更小,更容易定位于前交叉韧带的解剖足迹上,实现韧带的等长重建。
Objective To compare the effect between two location methods on femoral tunnel in anterior cruciate ligament reconstruction. Methods A total of 80 patients undergoing single-bundle anterior cruciate ligament reconstruction with hamstring autografts were selected as subjects,and were randomly divided into femoral tunnel using transtibial approach group( TT group) and femoral tunnel using anteromedial portal group( AM group),with 40 cases in each group. The length of femoral tunnel was recorded during operation,the angle of femoral tunnel in the coronal and sagittal views and the relative position of femoral termination away from Blumensaat line were measured and calculated in X-ray images after operation,and then statistical analysis was performed. Results The femoral tunnel length of the TT group was significantly longer than that of the AM group [( 47. 13 ± 6. 78) mm vs.( 42. 10 ± 4. 65) mm,P < 0. 05]. The angles in coronal/sagittal views of the TT group and the AM group were( 53. 33 ± 6. 68) °/( 44. 45 ± 8. 59) ° and( 45. 25 ± 4. 93) °/( 37. 13 ± 6. 52) ° respectively,and statistical differences were observed between the two groups( P < 0. 05). The relative positions of the femoral termination were( 61. 22 ± 6. 09) % and( 65. 01 ± 4. 83) % in the TT group and the AM group respectively,and statistical difference was observed between the two groups( P < 0. 05).Conclusion Compared with the TT technique,the femoral tunnel established by AM technique obtains shorter length and smaller angle,can be located on the anatomical footprint of the anterior cruciate ligament more easily,and achieves equal length reconstruction.
Objective To compare the effect between two location methods on femoral tunnel in anterior cruciate ligament reconstruction. Methods A total of 80 patients undergoing single-bundle anterior cruciate ligament reconstruction with hamstring autografts were selected as subjects,and were randomly divided into femoral tunnel using transtibial approach group( TT group) and femoral tunnel using anteromedial portal group( AM group),with 40 cases in each group. The length of femoral tunnel was recorded during operation,the angle of femoral tunnel in the coronal and sagittal views and the relative position of femoral termination away from Blumensaat line were measured and calculated in X-ray images after operation,and then statistical analysis was performed. Results The femoral tunnel length of the TT group was significantly longer than that of the AM group [( 47. 13 ± 6. 78) mm vs.( 42. 10 ± 4. 65) mm,P < 0. 05]. The angles in coronal/sagittal views of the TT group and the AM group were( 53. 33 ± 6. 68) °/( 44. 45 ± 8. 59) ° and( 45. 25 ± 4. 93) °/( 37. 13 ± 6. 52) ° respectively,and statistical differences were observed between the two groups( P < 0. 05). The relative positions of the femoral termination were( 61. 22 ± 6. 09) % and( 65. 01 ± 4. 83) % in the TT group and the AM group respectively,and statistical difference was observed between the two groups( P < 0. 05).Conclusion Compared with the TT technique,the femoral tunnel established by AM technique obtains shorter length and smaller angle,can be located on the anatomical footprint of the anterior cruciate ligament more easily,and achieves equal length reconstruction.
引文
[1]谢国明,董士奎,皇甫小桥,等.保留胫骨残端重建前交叉韧带对韧带重塑相关基因表达的影响[J].中国修复重建外科杂志,2016,30(1):15-20.
[2]da Silva RR,Matos MA,Costa VCNB,et al.Tomographic Study of Femoral Positioning in Anterior Cruciate Ligament Reconstruction Using the Transtibial Technique[J].Knee Surg Relat Res,2017,29(3):195-202.
[3]Kumar S,Kumar A,Kumar R.Accurate Positioning of Femoral and Tibial Tunnels in Single Bundle Anterior Cruciate Ligament Reconstruction Using the Indigenously Made Bernard and Hurtle Grid on a Transparency Sheet and C-arm[J].Arthrosc Tech,2017,6(3):e757-e761.
[4]Khalfayan EE,Sharkey PF,Alexander AH,et al.The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction[J].Am JSports Med,1996,24(3):335-341.
[5]MARS Group,Allen CR,Anderson AF,et al.Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction[J].Am J Sports Med,2017,45(11):2586-2594.
[6]Falciglia F,Panni AS,Giordano M,et al.Anterior cruciate ligament reconstruction in adolescents(Tanner stages 2 and 3)[J].Knee Surg Sports Traumatol Arthrosc,2016,24(3):807-814.
[7]Iriuchishima T,Ryu K,Suruga M,et al.The correlation of femoral tunnel length with the height and area of the lateral wall of the femoral intercondylar notch in anatomical single-bundle ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2017,25(2):1632-1637.
[8]Robin BN,Jani SS,Marvil SC,et al.Advantages and Disadvantages of Transtibial,Anteromedial Portal,and Outside-In Femoral Tunnel Drilling in Single-Bundle Anterior Cruciate Ligament Reconstruction:A Systematic Review[J].Arthroscopy,2015,31(7):1412-1417.
[9]Domnick C,Herbort M,Raschke MJ,et al.Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique,whereas medial-portal-aiming devices with larger offset hit the center reliably[J].Arch Orthop Trauma Surg,2016,136(4):499-504.
[10]Ayala-Mejias JD,Garcia-Gonzalez B,Alcocer-PerezEspa珘na L,et al.Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis:30 Patients at a Minimum Follow-Up of 10 Years[J].JKnee Surg,2016,30(6):501-508.
[11]Lee DW,Kim JG.Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Modified Transtibial Technique[J].Arthrosc Tech,2017,6(1):e227-e232.
[12]Macdonald P,Kim C,McRae S,et al.No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction:a prospective randomized,controlled trial[J].Knee Surg Sports Traumatol Arthrosc,2018,26(5):1335-1342.
[13]徐虎,张春礼,李光政,等.前交叉韧带重建中两种建立股骨隧道方法的比较[J].中国矫形外科杂志,2013,21(8):746-750.
[14]Kadija M,Milovanovi D,Bumbairevi M,et al.Length of the femoral tunnel in anatomic ACL reconstruction:comparison of three techniques[J].Knee Surg Sports Traumatol Arthrosc,2017,25(5):1606-1612.
[15]高冠奇,张克远.CT图像后处理重建膝关节三维模型:3D-CT评估前交叉韧带重建后的骨道差异[J].中国组织工程研究,2015,19(40):6397-6401.
[16]Sinha S,Naik AK,Arya CS,et al.Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction[J].Indian J Orthop,2015,49(3):352-356.
[17]Farrow LD,Morris PM,Huston KL,et al.A Simple Radiographic Sign of Vertical Anterior Cruciate Ligament Tunnel Placement[J].J Knee Surg,2015,28(5):428-431.
[18]韩晓鹏,纪斌平.前交叉韧带重建术止点定位的临床研究[J].中国矫形外科杂志,2008,16(8):574-576,590.
[19]Kim KI,Lee SH,Bae C,et al.Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction:A Comparison of the Anteromedial Portal and Outside-in Techniques[J].Knee Surg Relat Res,2017,29(1):11-18.
[2]da Silva RR,Matos MA,Costa VCNB,et al.Tomographic Study of Femoral Positioning in Anterior Cruciate Ligament Reconstruction Using the Transtibial Technique[J].Knee Surg Relat Res,2017,29(3):195-202.
[3]Kumar S,Kumar A,Kumar R.Accurate Positioning of Femoral and Tibial Tunnels in Single Bundle Anterior Cruciate Ligament Reconstruction Using the Indigenously Made Bernard and Hurtle Grid on a Transparency Sheet and C-arm[J].Arthrosc Tech,2017,6(3):e757-e761.
[4]Khalfayan EE,Sharkey PF,Alexander AH,et al.The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction[J].Am JSports Med,1996,24(3):335-341.
[5]MARS Group,Allen CR,Anderson AF,et al.Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction[J].Am J Sports Med,2017,45(11):2586-2594.
[6]Falciglia F,Panni AS,Giordano M,et al.Anterior cruciate ligament reconstruction in adolescents(Tanner stages 2 and 3)[J].Knee Surg Sports Traumatol Arthrosc,2016,24(3):807-814.
[7]Iriuchishima T,Ryu K,Suruga M,et al.The correlation of femoral tunnel length with the height and area of the lateral wall of the femoral intercondylar notch in anatomical single-bundle ACL reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2017,25(2):1632-1637.
[8]Robin BN,Jani SS,Marvil SC,et al.Advantages and Disadvantages of Transtibial,Anteromedial Portal,and Outside-In Femoral Tunnel Drilling in Single-Bundle Anterior Cruciate Ligament Reconstruction:A Systematic Review[J].Arthroscopy,2015,31(7):1412-1417.
[9]Domnick C,Herbort M,Raschke MJ,et al.Conventional over-the-top-aiming devices with short offset fail to hit the center of the human femoral ACL footprint in medial portal technique,whereas medial-portal-aiming devices with larger offset hit the center reliably[J].Arch Orthop Trauma Surg,2016,136(4):499-504.
[10]Ayala-Mejias JD,Garcia-Gonzalez B,Alcocer-PerezEspa珘na L,et al.Relationship between Widening and Position of the Tunnels and Clinical Results of Anterior Cruciate Ligament Reconstruction to Knee Osteoarthritis:30 Patients at a Minimum Follow-Up of 10 Years[J].JKnee Surg,2016,30(6):501-508.
[11]Lee DW,Kim JG.Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Using the Modified Transtibial Technique[J].Arthrosc Tech,2017,6(1):e227-e232.
[12]Macdonald P,Kim C,McRae S,et al.No clinical differences between anteromedial portal and transtibial technique for femoral tunnel positioning in anterior cruciate ligament reconstruction:a prospective randomized,controlled trial[J].Knee Surg Sports Traumatol Arthrosc,2018,26(5):1335-1342.
[13]徐虎,张春礼,李光政,等.前交叉韧带重建中两种建立股骨隧道方法的比较[J].中国矫形外科杂志,2013,21(8):746-750.
[14]Kadija M,Milovanovi D,Bumbairevi M,et al.Length of the femoral tunnel in anatomic ACL reconstruction:comparison of three techniques[J].Knee Surg Sports Traumatol Arthrosc,2017,25(5):1606-1612.
[15]高冠奇,张克远.CT图像后处理重建膝关节三维模型:3D-CT评估前交叉韧带重建后的骨道差异[J].中国组织工程研究,2015,19(40):6397-6401.
[16]Sinha S,Naik AK,Arya CS,et al.Trans-tibial guide wire placement for femoral tunnel in single bundle anterior cruciate ligament reconstruction[J].Indian J Orthop,2015,49(3):352-356.
[17]Farrow LD,Morris PM,Huston KL,et al.A Simple Radiographic Sign of Vertical Anterior Cruciate Ligament Tunnel Placement[J].J Knee Surg,2015,28(5):428-431.
[18]韩晓鹏,纪斌平.前交叉韧带重建术止点定位的临床研究[J].中国矫形外科杂志,2008,16(8):574-576,590.
[19]Kim KI,Lee SH,Bae C,et al.Three-Dimensional Reconstruction Computed Tomography Evaluation of the Tunnel Location and Angle in Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction:A Comparison of the Anteromedial Portal and Outside-in Techniques[J].Knee Surg Relat Res,2017,29(1):11-18.