采用激光技术实现经胫骨隧道单束解剖重建前交叉韧带的可行性研究

The feasibility of applying laser positioning device to the transtibial tunnel technique to achieve single-bundle reconstruction of anterior cruciate ligament

背景:经胫骨隧道技术(transtibial,TT)可实现前交叉韧带(anterior cruciate ligament,ACL)的等长重建,而其实现解剖重建的能力存在争议。目的:探讨采用激光定位技术实现ACL解剖重建的可行性。方法:选取25具完整尸体,剥离膝关节前部软组织充分暴露至韧带表面,使用外固定架固定膝关节于屈曲90°位置,去除前交叉韧带。将膝关节内ACL止点足印区(下简称止点)的中心点作为骨隧道内口,使用"双面激光技术"虚拟ACL的空间构象,确定胫骨及股骨骨隧道的关节外口,测量样本解剖数据及隧道相关数据。结果:男女比例为19:6,平均年龄(59.5±11.1)岁,平均身高(164.92±7.27)cm,髌腱长度(35.23±5.10)mm,胫骨横径(73.50±4.89)mm,胫骨前后径(45.18±4.02)mm;胫骨止点长度为(15.75±2.44)mm;胫骨止点的宽度(8.00±1.28)mm;股骨止点长度(15.39±2.17)mm,股骨止点宽度(8.97±1.61)mm,股骨止点与后壁的距离(2.61±0.62)mm,外侧髁间嵴出现的概率为76%,外侧分叉嵴出现的概率为49%。屈曲90°时,胫骨隧道长度(31.83±4.09)mm,距离胫骨平台(16.33±4.56)mm,距离髌腱内侧(10.79±5.85)mm;距离内侧副韧带(23.12±5.99)mm;股骨隧道长度(42.70±7.83)mm。上述指标左右膝差异无统计学意义(P>0.05)。结论:胫骨止点前后径较小,建议采用单束解剖重建较为适当,宽度建议取8 mm左右为宜;通过"双面激光技术"可以模拟膝关节中ACL的空间构象,在减少骨质损伤的前提下可测量一个膝关节的多个角度;在屈曲90°时,经胫骨隧道技术可以安全进行单束解剖重建ACL。

Background： The transtibial tunnel technique can achieve equal length reconstruction of the anterior cruciate ligament（ACL）. However, whether it can achieve anatomical reconstruction is still not clear. Objective： To investigate whether anatomical reconstruction can be achieved by transtibial tunnel technique with the assist of laser positioning device.Methods： A total of 25 complete corpses were selected, the anterior soft tissue of their knee joints was detached so that the ligamentous surface was fully exposed, then the knee joints were fixed at 90° with an external fixator, and the ACL was removed. The central point of knee ACL footprint area was marked as internal opening of the bone tunnel, and ＂double-sided laser technology＂ was used to establish a fictitious spatial conformation of ACL. The outside opening of tibial and femoral bone tunnel was determined, and the anatomical data of the sample and the related data of the tunnel were obtained. Results：There were 19 males and 6 females with an average age of（59.5±11.1） years and an average height of（164.92±7.27） cm.The average patellar tendon length, tibial transverse diameter, tibial antero-posterior diameter, tibial eminence length, tibial eminence width, femoral attachment length, femoral attachment width and the distance between femoral attachment and posterior wall were（35.23±5.10） mm,（73.50±4.89） mm,（45.18±4.02） mm,（15.75±2.44） mm,（8.00±1.28） mm,（15.39±2.17）mm,（8.97±1.61） mm and（2.61±0.62） mm. The incidence of the intercondylar eminence was 76% and that of the bifurcation eminence was 49%. When the flexion reached 90°, the tibial tunnel length, the distance to tibial plateau, the distance to patellar tendon, the distance to medial collateral ligament and the femoral tunnel length were（31.83 ± 4.09） mm,（16.33 ±4.56） mm,（10.79±5.85） mm,（23.12±5.99） mm and（42.70±7.83） mm. The above indexes for both sides of knees were correlated with no statistically significant differences. Conclusions： The tibial eminence antero-posterior diameter is relatively shorter, therefore in the south Jiangsu region, it is appropriate to recommend single-bundle anatomical reconstruction as surgical method of ACL, with the recommended width of 8 mm. The spatial conformation of ACL can be simulated by ＂doublesided laser technology＂, which could measure multiple angles of a knee joint on the premise that bone damage is reduced.When the flexion reaches 90°, the transtibial tunnel technique can safely achieve single-bundle reconstruction of ACL.