后软骨缘顶点辅助定位器进行前交叉韧带I.D.E.A.L股骨骨道定位

I.D.E.A.L Femoral Tunnel Drilling for Anterior Cruciate Ligament Reconstruction Using the Auxiliary Locator with Apex of the Deep Cartilage as a Landmark

目的:探索一种可以在前交叉韧带(ACL)股骨残端不清晰的病例中简单有效定位I.D.E.A.L骨道位置的方法。方法:回顾性分析2019年1月至2020年10月ACL单束重建的46例患者。其中残端较为完整的23例纳入对照组;无残端的23例纳入观察组。对照组男性20例,女性3例;16例为右腿,7例为左腿;年龄30.57±6.39岁;身高173.91±7.08 cm;BMI 24.91±3.82 kg/m^(2)。观察组男性19例,女性4例;15例为右腿,8例为左腿;年龄29.48±9.97岁;身高175.30±7.03 cm;BMI 24.70±3.77 kg/m^(2)。对照组I.D.E.A.L股骨骨道的制备依靠术中直视下用射频在残端区域做标记,并观察将定位器卡在髁间窝外侧壁后软骨缘顶点(ADC)上时定位器与外侧胫骨平台的关系。观察组I.D.E.A.L股骨骨道的制备依靠定位器与外侧胫骨平台成平行关系来定位骨道中心。术后通过三维CT测量ADC至前骨缘的水平距离(L)和ADC至骨道中心的水平距离(l),通过l/L计算骨道前后位置R;在二维横断面上测量骨道中心到下骨缘的距离(D)。将对照组数据定义为l1、L1、R1和D1;观察组数据定义为l2、L2、R2和D2。利用独立样本t检验比较两组之间的R和D值,从而判断该定位方法的稳定性和可重复性。结果:两组之间入组病例数相同,年龄、性别、身高、BMI和侧别上无统计学差异,具有可比性。两组患者术后CT测量发现,对照组骨道中心的前后位置R1为38.69%±4.82%;观察组骨道中心的前后位置R2为38.27%±4.60%。对照组骨道中心距离下骨缘距离D1为9.12±0.74 mm;观察组骨道中心距离下骨缘距离D2为8.52±1.62 mm。两组骨道位置之间无统计学差异。结论:在前交叉韧带重建术中,以髁间窝外侧壁后软骨缘顶点(ADC)为标志,4字位放置膝关节,在屈膝120°时使用off center股骨定位器,当定位器与外侧胫骨平台平行时可以有效地定位到I.D.E.A.L股骨骨道的中心;该方法可重复性好。

ObjectiveTo explore a simple and effective technique to realize the positioning of I.D.E.A.L femoral tunnel in the anterior cruciate ligament(ACL)reconstruction.MethodsTotally 46 patients undergoing single anterior cruciate ligament reconstruction between January 2019 and October 2020 in our hospital were reviewed.Among them,23 patients with complete femoral remnant were selected into the control group,while the rest 23 without femoral remnant were chosen into the experimental group.The control group included 20 males and 3 females with a mean age of 30.57±6.39,an average height and body mass index(BMI)of 173.91±7.08 cm and 24.91±3.82 kg/m^(2),with 16 right legs and 7 left legs affected,while the observation group was made up of 19 males and 4 females with a mean age of 29.48±9.97,and an average height and BMI of 175.30±7.03 cm and 24.70±3.77 kg/m^(2),as well as 15 right legs and 8 left legs affected.The center of I.D.E.A.L femoral tunnel was marked with an electrocautery device and found the parallel relationship between the Auxiliary Locator against the apex of the deep cartilage(ADC)and lateral tibial plateau in the control group,while in the observation group,the center was positioned using Auxiliary Locator when it was parallel to the tibial plateau.On the post-operative CT scan,the distances from the ADC to the center of femoral tunnel(l),to the anterior cartilage margin(L),and the distance from the center to the distal cartilage margin(D)were measured.The ratio of I/L was calculated(R).Data of the control group were defined as l1,L1,R1,and D1,while those of the observation group were defined as l2,L2,R2,and D2.Data of normal distribution were compared with t-test while those not normally distributed were analyzed using the Mann-Whitney test.ResultsNo significant differences were found between the two groups in the number of cases,age,gender,height,BMI and affected legs.According to the postoperative CT results,the average R_(1) and R_(2) were 38.69%±4.82%and 38.27%±4.60%,and the average D1and D2were 9.12±0.74 mm and 8.52±1.62 mm,showing no significant differences between the two groups.ConclusionDuring ACL reconstruction,the knee joint is placed in a 4-shaped position marked by the posterior edge of cartilage(ADC)on the lateral wall of the intercondylar fossa,and the off center femoral locator is used at 120°of the knee flexion.When the locator is parallel to the lateral tibial plateau,the center of the I.D.E.A.L femoral canal can be effectively located.This method is of good repeatability.