前交叉韧带重建股骨足迹精确定位的解剖与临床研究
Anatomy and clinical investigation on the pinpoint of footprint in the in-situ anterior cruciate ligament reconstruction
目的 探讨前交叉韧带(ACL)个性化解剖重建术中韧带止点足迹精确定位的方法及效果。 方法 ①15侧膝关节尸体标本,标记ACL股骨足迹,观察ACL足迹长轴与股骨干角度、前内束(AM)中心位点距后软骨缘距离、后外束(PL)中心位点距下软骨缘距离。②15例行ACL重建患者,术中采用三入路观察与导航定位方法明确ACL股骨足迹,测量AM与PL连线与股骨干夹角、AM距后软骨缘距离、PL距下软骨缘距离。 结果 15例膝关节尸体标本ACL股骨足迹长轴与股骨干角度为(18.5± 2.5)°、AM与股骨外髁内面后缘距离为(6.1±1.8)mm、PL距离下软骨缘距离为(6.2±2.2)mm,但每个标本均不相同。导航显示,ACL股骨足迹长轴与股骨干夹角为(19.3±3.1)°,AM与股骨外髁内面后缘为(5.8±1.2)mm、PL距离下软骨缘为(5.9±2.5)mm,各数据相差较大。 结论 ①ACL股骨与胫骨解剖足迹变异较大,应根据每例ACL足迹不同进行精确的个性化解剖重建。②以同一个标准进行所有ACL重建难以达到真正的解剖重建。
Objective To study the pinpoint of footprint during the individual in-situ reconstructing of anterior cruciate ligament(ACL). Methods The footprints of femur were detected on 15 healthy knee specimen, and 15 cases with ACL rupture and underwent ACL reconstruction procedure by navigation. The angle between the axis of ACL footprint and the shaft of femur, the distance from the center of AM to posterior margin of femoral condyle, PL to the inferior margin of cartilage were detected, both in specimen and ACL reconstruction cases. Results The angle between the axis of ACL footprint and the shaft of femur was about (18.5±2.5)° and (19.3±3.1)° for specimens and patients respectively; The distance from the AM to medial surface of lateral condyle of femur was (6.1±1.8)mm and (5.8±1.2)mm; The distance from PL to the edge of inferior cartilage was about (6.2±2.2)mm and (5.9±2.5)mm respectively; The values of parameter were different for different samples and cases. Conclusions The footprints of ACL on the femur and the tibia are variant both in specimens and patients. During in-situ ACL reconstruction procedure, individual ACL footprint measurement should be performed.
前交叉韧带 / 足迹 / 个性化 / 精确定位 / 临床解剖
Anterior cruciate ligament / Footprint;   / Individual / Pinpoint / Clinical anatomy
[1] Musahl V, Bedi A, Citak M, et al. Effect of single-sundle and double-bundle anterior cruciate ligament reconstructions on pivot-shift kinematics in anterior cruciate ligament- and meniscus-deficient knees
[J]. Am J Sports Med, 2010, 38(12) 817-210.
[2] Iriuchishima T, Horaguchi T, Kubomura T, et al. Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT
[J]. Knee Surg Sports Traumatol Arthrosc, 2011,19(4):674-679.
[3] Taketomi S, Nakagawa T, Takeda H, et al. Anatomical placement of double femoral tunnels in anterior cruciate ligament reconstruction: anteromedial tunnel first or posterolateral tunnel first
[J] ? Knee Surg Sports Traumatol Arthrosc, 2010, 38(9): 561-564.
[4] Murray PJ, Alexander JW, Gold JE, et al. Anatomic double-bundle anterior cruciate ligament reconstruction: kinematics and knee flexion angle-graft tension relation
[J].Arthroscopy, 2010, 26(2):202-213.
[5] Snow M, Stanish WD. Double-bundle ACL reconstruction: how big is the learning curve
[J] ? Knee Surg Sports Traumatol Arthrosc,2010, 18(9):1195-200.
[6] 余家阔,敖英芳,于长隆,等.前交叉韧带四骨道双束重建的解剖学及临床研究
[J]. 中华医学杂志, 2009, 89(29):2019-2024.
[7] Aglietti P, Buzzi R, Menchetti PM, et al. Arthroscopically assistedsemitendinosus and gracilis tendon graft in reconstruction for acuteanterior cruciate ligament injuries in athletes
[J]. Am J Sports Med, 1996, 24(8):726-731.
[8] Bach BR Jr, Levy ME, Bojchuk J, et al. Single-incision endoscopic anterior cruciate ligamentreconstruction using patellar tendon autograft: minimum two-yearfollow-up evaluation
[J]. Am J Sports Med, 1998, 26(1):30-40.
[9] Chen CH, Chuang TY, Wang KC, et al. Arthroscopicanterior cruciate ligament reconstruction with quadriceps tendonautograft: clinical outcome in 4-7 years
[J].Knee Surg Sports Traumatol Arthrosc, 2006,14(10):1077-1085.
[10] Ejerhed L, Kartus J, Sernert N, et al. Patellar tendonor semitendinosus tendon autografts for anterior cruciate ligamentreconstruction? A prospective randomized study with a two-yearfollow-up
[J]. Am J Sports Med, 2003, 31(1):19-25.
[11] Shino K, Horibe S, Hamada M, et al. Allograft anterior cruciate ligament reconstruction
[J]. Tech Knee Surg, 2002, 1(1):78-85.
[12] Zavras TD, Race A, Bull AM, et al. A comparative study of `isometric' points for anterior cruciate ligAMent graft attachment
[J]. Knee Surg Sports Traumatol Arthrosc,2001,9(1):28-33.
[13] Wongchaisuwat C,Hemami H,Bucher HJ.Control of sliding and rolling at natural joints
[J].J Biomech Eng,1984,106(4):368-375.
[14] Hoshino Y, Nagamune K, Yagi M. The effect of intra-operative knee flexion angle on determination of graft location in the anatomic double-bundle anterior cruciate ligament reconstruction
[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9):1052-1060.
[15] Hoshino Y, Kuroda R, Nagamune K, et al. The effect of graft tensioning in anatomic 2-bundle ACL reconstruction on knee joint kinematics
[J]. Knee Surg Sports Traumatol Arthrosc, 2007, 15(5):508-514.
[16] Yagi M, Kuroda R, Nagamune K, et al. Double-bundle ACL reconstruction can improve rotational stability
[J]. Clin Orthop Relat Res, 2007, 454:100-107.
[17] 赵金忠,皇甫晓桥. 保留并牵张胫骨残端的前交叉韧带双束重建
[J]. 中华关节外科杂志(电子版),2009, 3(2):4-7.
[18] 张春礼,徐虎, 范宏斌,等.前交叉韧带解剖双束重建中股骨隧道建立路径的比较研究
[J].中华关节外科杂志(电子版),2009,3(2):16-19.
[19]严广斌.单束重建与双束重建
[J].中华关节外科杂志(电子版), 2009,3 (20):61.
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