前交叉韧带双束重建解剖影像学研究

Anatomic and radiograph study of double-bundle anterior cruciate ligament reconstruction

目的测量并研究标准膝关节侧位X线片上前交叉韧带（ACL）股骨止点的相关骨性标志数据,为临床ACL重建提供参考。方法对10例成人膝关节标本进行解剖观察,标记ACL股骨止点前内侧束和后外侧束,摄标准膝关节正侧位X线片,利用图像分析软件测量两束止点中心（前内侧束为A点,后外侧束为B点）与股骨后髁弧形中心（i点）的距离,测量A点与过顶点、B点与过顶点的距离。结果解剖观察表明,ACL在中段根据其纤维走行及屈伸过程中的松紧变化,较易分为2束。A点与i点的距离为3.08~7.33（5.40±1.56）mm,B点与i点的距离为3.42~7.15（5.40±1.31）mm,A、B点与i点的距离差异无统计学意义（t=0.198,P=0.848）。A点与过顶点的距离为7.60~12.40（9.90±1.60）mm,B点与过顶点的距离为13.50~18.60（15.70±1.70）mm。结论股骨外髁弧形中心（单束重建等长点）与ACL前内侧束、后外侧束中心等距,支持单隧道双束重建ACL的理论要求。

Objective To measure and study the distance relationship between femoral footprint ACL and femoral condylar landmarks on a standard knee joint lateral X-ray, in order to provide reference for clinical ACL reconstruction. Methods Ten human cadaveric knees disposaled in formalin were anatomized. A mark was made on the footprint of anterior cruciate attachment, ACL was divided into anteromedial bundle and posterlateral bundle, and a standard knee joint lateral X-ray was taken. The distance between the centre of two bundle（the anteromedial bundle was A point, the posterolateral bundle was B point） and the centre point of femoral condyle arc were measured by using the image analysis software. The distance between theover-the-topposition and point A, point B were measured. Results The anatomy observation showed that, in the middle of the ACL according to elastic change of the fiber and the flexion and extension process, it was easy to be divided into two bundles. The distance between point A and point i was 3.08-7.33（5.40 ±1.56） mm, the distance between point B and point i was 3.42-7.15（5.40±1.31）mm. There were no significant differences（t =0.198,P =0.848）. The distance between point A and over-the-topposition was 7.60-12.40（9.90±1.60）mm, and the distance between point B and over-the-topposition was 13.50-18.60（15.70±1.70）mm. Conclusion The distance between the centre of AM, PL and the centre point of femoral condyle arc is equal, which supports the theory of the single tunnel double bundle reconstruction.