基于3D-CT的前交叉韧带保残重建与不保残重建术后胫骨骨隧道位置的比较研究

Comparative Study of the Tibial Tunnel Position after Remnant and Non-remnant Preservation Techniques Based on 3D-CT

目的:探讨前交叉韧带(anterior cruciate ligament,ACL)保残重建与不保残重建胫骨骨隧道的位置差异。方法:本研究是一项病例对照研究,回顾性收集了46例单纯ACL断裂的成年患者。实施保残重建患者满足ACL胫骨端残端>25%,实施不保残重建患者术中不保留ACL胫骨端残端。术后第二天行三维CT(three-dimensional computer tomography,3D-CT)检查,并对图像进行三维重建,使用网格法构建X和Y轴坐标系(定义股骨从内侧到外侧为X轴,从前到后为Y轴),评估胫骨骨隧道出口的位置。将保残组与不保残组直接比较,对照已发表的ACL胫骨解剖止点数据,评估两种重建技术的准确性和精确性。结果:本研究最终纳入41例,其中保残组20人,不保残组21人。保残组(X轴:45.40%±3.18%,Y轴:39.22%±5.50%)和不保残组(X轴:44.87%±3.60%,Y轴:39.11%±6.37%)骨隧道出口位置无显著差异,对照已发表的ACL胫骨解剖止点数据,两组胫骨骨隧道出口的精确性(4.05%vs 3.27%)和准确性(5.99%vs 7.64%)无显著差异。结论:保残重建与不保残重建术后的胫骨骨隧道出口位置无显著差异。保残对提高胫骨骨隧道定位的准确性帮助不明显。

Objective To explore the difference in the tibial tunnel position in the reconstruction of anterior cruciate ligament(ACL) using the remnant and non-remnant preservation techniques. Methods Totally 46 adult patients with ACL rupture were studied retrospectively. Patients undergoing ACL reconstruction with remnant preservation technique(the remnant preservation group) were preserved the ACL tibial end stump>25%,while those undergoing ACL non-remnant preservation technique(the non-remnant preservation group) were not. Three-dimensional reconstruction CT(3D-CT) was performed on the2nd day after the surgery,and the image was reconstructed three-dimensionally to evaluate the position of the exit of the tibial tunnel(measured by the grid method). The accuracy and precision of the two reconstruction techniques were evaluated by comparing their ACL tibial anatomical data,as well as comparing to those published data. Results Forty-one patients were included in this study,with 20and 21 patients in the remnant and non-remnant preservation groups respectively. There was no significant difference between the remnant preservation group(X axis:45.40% ± 3.18%,Y axis:39.22% ±5.50%) and the non-remnant preservation group(X axis: 44.87% ± 3.60%, Y axis: 39.11% ±6.37%) in the exit of the tibial tunnel. Moreover,compared with published literature,no significant differences were observed in the precision(4.05% vs 3.27%) and accuracy(5.99% vs 7.64%) of the two procedures. Conclusions There is no significant difference in the exit position of the tibial tunnel between using the two different surgical methods. Remnant preservation does not obviously improve the accuracy of tibial bone tunnel localization.