3D打印辅助关节镜下前交叉韧带等长重建股骨隧道定位的研究

Research of 3D printing assisted arthroscopic reconstruction of anterior cruciate ligament to locate isometric point of femoral tunnel

目的评价利用3D打印技术打印膝关节模型辅助关节镜下前交叉韧带(ACL)等长重建的意义,并寻找等长重建股骨隧道定位的最佳区域。方法选取2018年6月-2019年2月就诊于新疆医科大学第一附属医院运动医学病区、经临床体格检查、磁共振成像(MRI)检查和膝关节镜下探查术诊断为ACL损伤的患者30例,行膝关节平扫+三维重建组合,建立患膝关节模型,将模型中的股骨和胫骨进行3D打印。将整个模型牢固安置在下肢被动运动训练机上,从0°伸直位至120°屈曲位,每10°为一个档位做屈伸运动,观察位移传感器显示器中的读数,算出长度变化。结果A点测得的长度变化为(9.70±0.66)mm,变异系数为2.13,B点测得的长度变化为(8.86±1.45)mm,变异系数为3.98,C点测得的长度变化为(8.90±1.27)mm,变异系数为3.75,D点测得的长度变化为(9.40±0.62)mm,变异系数为2.04,E点测得的长度变化为(9.90±0.65)mm,变异系数为2.14。结论对30例ACL损伤患者的膝关节不同隧道进行测量,基于已成共识的胫骨隧道定位点,以A、D、E三点围成的三角形为关节镜下ACL等长重建最理想的股骨隧道钻孔区域。在此三点围成的区域,重建的ACL都可以达到等长的效果,是手术重建的最佳区域。

Objective To evaluate the application of 3D printing technology printed the knee joint model to assist the arthroscopic reconstruction of the anterior cruciate ligament,and find the optimal region for the reconstruction of the femoral tunnel.Methods 30 patients who were diagnosed as“anterior cruciate ligament injury”by clinical physical examination,MRI examination and knee arthroscopy from June 2018 to February 2019.The knee joint was cleaned and three-dimensional reconstruction was performed.The knee joint model was established and the femur and tibia in the model were established and make 3D printing.The whole model was firmly placed on the lower limb continuous passive motion training machine,from 0°to the 120°flexion position,and the reading in the displacement sensor display was observed by its movement every 10°to calculate the length change.Results The change in length measured at point A was(9.70±0.66)mm,the coefficient of variation was 2.13,the change in length measured at point B was(8.86±1.45)mm,the coefficient of variation was 3.98,and the change in length of point C was(8.90±1.27)mm,the coefficient of variation is 3.75,the length of the D point is(9.40±0.62)mm,the coefficient of variation is 2.04,the length of the E point is(9.90±0.65)mm,and the coefficient of variation is 2.14.Conclusion For the measurement of 30 different tunnels of knee joints in patients with anterior cruciate ligament injury,we found that the triangles surrounded by the three points A,D and E are the isometric length of the articular anterior cruciate ligament based on the consensus of the tibial tunnel.The arthroscopic reconstruction of the anterior cruciate ligament in the area surrounded by the three points can achieve the isometric length and is an optimal area for surgical reconstruction.