前交叉韧带重建术的精确定位

Precise positioning for reconstruction of anterior cruciate ligament

目的探讨前交叉韧带（ＡＣＬ）重建的定位方法。方法取２０例新鲜或冷冻保存的尸体膝关节，通过做骨道至股骨和胫骨的ＡＣＬ附丽区，穿以钢丝并被动屈曲膝关节，测得其长度参数。用自行研制的等距测尺，连续观察测值的变化。结果在３０°～１２０°屈曲过程中，前上区纤维由短变长，前方制约作用逐渐增加；后上及中心区纤维的长度变化很小；前下区及后下区纤维由长变短，前方制约作用逐渐减少。结论股骨附丽区后上区和中心区应视为ＡＣＬ的重建位置。在陈旧损伤附丽区标志不明时，可使用等距测尺来决定重建位置中心。

Objective To supply the basement for precise positioning for anterior cruciate ligament (ACL) reconstruction in the knee and recommend a precise measurement method during the operation. Methods Bone tunnels along ACL attachments were made in 20 cadaveric knees. Steel wire was introduced through the tunnel and the length changes were measured during passive knee flexion. We developed an Isometer for getting continuous parameters. Results Anterosuperior (AS) fibers were lengthened during knee flexion from 30 to 120 degrees, combined with the increase of anterior restraints. Length changes of the posterosuperior and central(C, PS) fibers were minimal. The length of the anteroinferior and poeteroinferior(AI and PI) fibers were shortened with the decrease of the anterior restraints. Conclusions The central and posterosuperior (C, PS) parts of femoral attachment would be the ideal reconstruction point. In case of old injury of ACL with ambiquous landmark, the Isometer is suggested in identifying the reconstruction point.