后交叉韧带重建锐角效应的临床解剖学研究

Clinical anatomical research on acute angle in posterior cruciate ligament reconstruction

目的探讨后交叉韧带(PCL)重建术中股骨骨道方向及屈膝角度对锐角效应的影响。方法解剖12具新鲜膝关节标本,切断PCL并标记两端止点中心O1、O2,标记股骨内上髁中心凹槽A、股内侧肌起点最远端的骨干中心点E,直线AE的4平分点B、C、D。以O1为圆心,不同骨道长度为半径,在股骨内侧髁前上象限骨面画弧,弧的两端及中点记为F、H、G。测量BO1、CO1、DO1、EO1的骨道长度,B、C、D、E点与O1O2的夹角,不同骨道长度(30、33、36、39、42 mm)时F、G、H点与O1O2的夹角,不同屈膝角度(0°、30°、60°、90°、120°)时C点与O1O2的夹角。结果 B、C 2点与O1O2的夹角差异无统计学意义(t=1.280,P=0.110);B点与O1O2的夹角明显大于D点(t=2.850,P=0.005)、E点(t=3.260,P=0.002)与O1O2的夹角,差异有统计学意义(P<0.05)。33、36 mm骨道组中F、G、H点与O1O2的夹角差异无统计学意义(P>0.05)。39 mm骨道组中H点与O1O2的夹角大于F点与O1O2的夹角,差异有统计学意义(t=-3.170,P=0.005)。不同屈膝角度中除90°与120°之间C点与O1O2的夹角差异无统计学意义外,其余各组差异均有统计学意义(P<0.05)。结论 PCL重建术中屈膝90°下由内向外技术建立较短的骨道长度及靠近前方的出口可以减小锐角效应。

Objective To explore the effect of femur tunnel position and knee flexion angle on acute angle in posterior cruciate ligament（PCL） reconstruction. Methods Twelve fresh-frozen human cadaveric knees were dissected to mark posterior cruciate ligament＇s footprint center point as O1、O2, sulcus of medial epicondyle of femur as A, distal beginning of vastus medialis＇ center named E, AE＇s quarter points named B, C, D. All the points were measured at 90°of knee flexion： the length of BO1, CO1, DO1, EO1, and line O1O2＇s angle. Arcs were made by different length, with the center O1. These arcs＇ border and middle were marked as F, H, G. Then of FO1, GO1, HO1 were measured, of CO1 in different knee flexion angles were measured. The anteroposterior and lateral plain X-rays were taken. Results ∠BO1O2 and ∠CO1O2 had no statistical differences （t = 1.280,P =0.110）, but ∠BO1O2 and ∠DO1O2 had （t =2.850,P =0.005）, ∠BO1O2 and ∠EO1O2 had （t =3.260,P =0.002）.∠FO1O2, ∠GO1O2, ∠HO1O2 had no statistical differences below 36 mm femur tunnel（P 〉0.05）, but had in 39 mm（t =-3.170, P=0.005）, ∠HO1O2〉 ∠FO1O2. All of flexion angle had statistical differences except ∠CO1O2 at 90° and 120° knee flexion. Conclusion At 90° knee flexion, inside-out technique can reduce acute angle by a shorter femur tunnel or an anterior exit.