计算机导航辅助关节镜下重建前交叉韧带

Computer-navigation assistance in arthroscopic reconstruction of anterior cruciate ligament

目的通过与传统关节镜下重建前交叉韧带(ACL)手术进行比较,说明基于X线影像的计算机导航系统辅助关节镜下重建ACL的手术方法隧道定位更精确。方法2005年12月-2006年3月共完成40例计算机导航系统辅助关节镜下ACL重建手术。选择2005年6月-2006年3月40例传统关节镜下ACL重建手术作为对照组,在X线片上分别测量胫骨隧道和股骨隧道的位置,对两组患者测量结果进行统计学分析。结果计算机导航系统辅助关节镜下ACL重建手术组测量股骨隧道位置平均值为62．3％±5．6％(52％-73％),传统手术组测量股骨隧道位置平均值为56．6％±7．3％(46％-77％)。胫骨隧道位置测量,导航辅助手术组平均值为45．4％±3．8％(37％-53％),传统手术组平均值为41．1％±6．0％(25％-54％)。两组患者的股骨隧道和胫骨隧道位置分别做统计学分析,差异均有显著性意义(P< 0．05)。导航辅助手术组数据更接近解剖重建ACL位置。计算机导航系统辅助关节镜下ACL重建的平均手术时间较传统手术延长20 min,透视次数为4次。结论基于X线影像的计算机导航系统辅助关节镜下ACL重建手术是安全、可行的,可以使股骨、胫骨隧道位置更精确。

Objective To compare traditional arthroscopic reconstruction of anterior cruciate ligament （ACL） and the arthroscopic ACL reconstruction assisted by fluoroscopy-based navigation system in accuracy and reproducibility of the tunnel placement, Methods Fluoroscopy-based navigation system was used in 40 cases of arthroscopic ACL reconstruction from December 2005 to March 2006, Another 40 cases of traditional arthroscopic ACL reconstruction performed between June 2005 and March 2006 were used as control, The positions of the femoral and tibial tunnels were measured on their radiograms and compared statistically, Results The femoral tunnel position measurements averaged 62, 3% ± 5, 6% （52% - 73% ） in navigation-assisted ACL reconstruction, and 56.6% ± 7. 3% （46% - 77% ） in the traditional arthroscopic operation, The tibial tunnel position measurements averaged 45.4% ± 3. 8% （37% -53% ） in the navigatlon-assisted ACL reconstruction, and 41. 1% ±6. 0% （25% -54% ） in the traditional arthruscopic operation. The differences were statistically significant （ P 〈 0. 05）. The mean operative duration for navigatlon-assisted ACL reconstruction was 20 minutes longer than that for traditional arthroscopic operation, Conclusion Arthroscopic ACL reconstruction assisted by fluoroscopy-based navigation system can improve the accuracy and reproducibility of the tunnel placement.