X线影像导航系统辅助关节镜下前交叉韧带重建术

Arthroscopic anterior cruciate ligament reconstruction guided by fluoroscopy-based navigation system

目的探讨 X 线影像导航系统辅助关节镜下前交叉韧带重建手术的可行性和隧道位置的精确性。方法 2005年12月至2006年2月共行 X 线影像导航系统辅助前交叉韧带重建手术30例(导航手术组),同期使用传统关节镜手术技术重建前交叉韧带40例(传统手术组),术前进行股骨、胫骨隧道理想位置的设计。术中 C 臂透视机获得正侧位影像后传输入计算机系统形成虚拟工作界面。膝关节周围分别固定股骨、胫骨追踪器。手术工具装配追踪器。经过注册及校准后,导航系统通过捕获追踪器发射的信号实时跟踪手术工具的位置方向,并叠加在工作界面上,达到导航的目的。本文对导航手术组进行总结,术后进行胫骨隧道位置测量,并与传统手术组进行比较。结果术后测量,导航手术组胫骨隧道位置平均值45.90%(41.00%～49.80%,标准差2.36%),传统手术组胫骨隧道位置在41.05%(范围25.00%～54.00%,标准差6.01%),两组结果差异有统计学意义(P<0.05)。同时导航组的平均手术时间较传统组延长20 min,透视次数为4次。术后短期随访(1～3个月),两组膝关节稳定性无明显差异。结论 X 线影像导航系统辅助关节镜下前交叉韧带重建手术是安全、可行的,通过术前规划,可以使股骨、胫骨隧道位置更精确。

Objective To introduce the process and outline of fluoroscopy-based navigation system assisted anterior cruciate ligament （ACL） reconstruction, and evaluate its feasibility and accuracy. Methods From September 2005 to February 2006, there were 30 cases ACL rupture patients who recieved fluoroscopybased navigation system assisted arthroscopy operations for ACL reconstruction （ navigation group）. At the same time, there were 40 patients who underwent traditional ACL operation （traditional group）. For the navigation group, the proper placement of femoral and tibial tunnels was planned preoperatively in standard AP and lateral X-ray view. Intraoperative fluoroscopic images were taken and input into navigation computer system to form the virtual interactive working fields. After placement and registration, signals from patient trackers, which fixed on the distal femur and tibia respectively, and tool trackers, which attached with ACL tibial and femoral guide, were captured by the optic navigation camera and the navigation computer system could pursue the real-time position of the ACL tools and projected into working field to help precise placement of femoral and tibial tunnels. Then results of two groups were observed and evaluated. Results For navigation group, the mean time extension was 20 min. The tibial tunnel position was measured in all these cases. The tibial tunnel position of navigation group was 45.90% （ SD 2. 36% ）, and the traditional group was 41.05% （SD 6.01% ）. The difference was statistically significant （P 〈0.05）. Conclusion Fluoroscopy-based navigation system assisted ACL reconstruction improves the accuracy and reproducibility of the tunnel placement.