前交叉韧带重建术中移植物等距特性与固定角度的影响

Study of Interaction between Isometric Feature of Grafts and Angle of Knee During Reconstruction of Anterior Cruciate Ligament

目的探讨前交叉韧带(ACL)重建的等距特性及移植物的等距特性与移植物固定角度的相互影响。方法选用10具新鲜冷冻尸体膝关节标本(10膝),在股骨和胫骨上各取3个常用的定位点,分别命名为股骨前束点、股骨误差点、股骨后束点和胫骨中心点、胫骨5mm后点、胫骨10mm后点。模拟ACL重建步骤,通过测量钢丝和等距测量器检测膝关节屈曲过程中股骨隧道内口与胫骨隧道内口间的距离变化。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无影响(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有显著差异(P<0.01)。结论ACL股骨前束隧道放置偏前、膝关节间的个体差异和移植物在不符合“距离变化—屈曲角度曲线”的角度上固定,是ACL重建术失败的主要因素。术中进行等距测量可以提高ACL重建的成功率。

Objective To explore the isometric feature of the reconstruction of anterior cruciate ligament（ACL） and the interaction between the isometric feature of the grafts and the angle of the knee when fixing the grafts. Methods The knee specimens from 10 fresh frozen cadavers were adopted. Three bone tunnels were drilled both in the femoral condyle and tibial plateau, and were named as femoral ＂anterior bundle point＂, femoral ＂error point＂, femoral ＂posterior bundle point＂, tibial ＂central point＂, tibial ＂5 mm posterior point＂, and tibial ＂10 mm posterior point＂, respectively. Simulating reconstruction of ACL, the changes of the distance between each pair of tibial and femoral tunnels during passive knee flexion-extension were detected with the aid of an isometer. Results Anteriorposterior shifting of the tibial tunnel was of no influence （P 〉0.05） on the isometric feature after the femoral tunnel was chosen. However, shifting of the femoral tunnel was of significant influence（P 〈0.01）on the isometric feature. Conclusion The anterior placement of the ＂anterior bundle point＂, individual diversity and graft fixation that is out of the ＂curve of distance change-flexion angle＂ are the main factors leading to reconstruction failures of ACL. Performing isometric measurement during operation can improve the success of reconstruction of ACL.