由外向内与经前内侧入路法重建前交叉韧带股骨隧道的比较

Femoral tunnels of outside-in method versus anteromedial portal technique in anterior cruciate ligament reconstruction

目的研究由外向内法(OI)与经前内侧入路法(AM)重建前交叉韧带(ACL)股骨侧隧道相关参数及隧道长度与股骨髁部大小的关系,探寻二者区别。方法取15具新鲜解冻膝关节标本,测量股骨髁部左右径及股骨外侧髁前后径大小,采用自行改进的内钩槽游标卡尺,定位ACL股骨侧止点中心,分别模拟采用OI法与AM法定位股骨外侧壁隧道口点。测量隧道长度、隧道口点与股骨外上髁位置关系。正侧位X线位上股骨隧道与膝关节线、股骨纵轴夹角。结果 OI法股骨隧道长度为(36.9±2.5)mm,AM法为(35.0±2.1)mm,差异有统计学意义(P<0.05);OI法与AM法股骨外侧壁隧道口点均位于股骨外上髁近前侧。OI法较AM法偏近心端分布,但AM法更为集中;股骨髁部越大,隧道长度越长。OI法较AM法隧道更为垂直。结论采用OI法与AM法均可满足ACL重建术对股骨隧道长度及位置的要求。OI法相比下更随意,不受屈膝角度的影响。

Objective To investigate the difference between the outside-in（ OI） method and anteromedial（ AM） portal by analyzing the parameters of femoral tunnel and the relationship between the length of the femoral tunnel and the size of femoral condyle during anterior cruciate ligament（ ACL）reconstruction. Methods Fifteen fresh cadaveric knees were selected to locate the center of ACL femoral footprint using the modified hook-slot vernier caliper and the tunnel entrance on the lateral side of femur using OI method and AM portal respectively. The femoral tunnel length,the relationship of the tunnel entrance and the lateral epicondyle,the angles formed by the tunnel,knee joint line and longitudinal femoral axis in the anteroposterior and lateral radiographs,and the size of femoral condyle were measured.Results The length of femoral tunnel according to OI method was significantly longer than AM portal（ P〈0. 05）. The entrances of the femoral tunnel both located at the lateral epicondyle of the femur proximal to the anterior region in OI and AM methods. The tunnel entrances of OI method located more proximally than those of AM portal,but they were more concentrated in AM portal. OI method showed a more vertical tunnel than AM portal. The bigger femoral condyles showed the longer femoral tunnel.Conclusion Both of OI method and AM portal can meet the requirements of femoral tunnel length and position in ACL reconstruction; OI method is more casual which is not influenced by the flexion angle of the knee.