前交叉韧带重建股骨骨道定位研究进展

Research progress of femoral bone tunnel positioning in anterior cruciate ligament reconstruction

目的对前交叉韧带(anterior cruciate ligament,ACL)重建手术中股骨骨道定位理念和定位方法进行综述,以期为临床治疗提供参考。方法广泛查阅国内外关于ACL重建术中股骨骨道定位理念及定位方法的研究文献,并对其归纳和总结。结果股骨骨道位置是决定ACL重建术预后的关键因素。ACL重建术股骨骨道定位理念经历了等长重建、解剖重建、Ribbon-like理论、I.D.E.A.L.理论和类等长重建理论。股骨骨道定位技术也随着对ACL解剖及生物力学的深入研究而不断变化,每种骨道定位技术各有优缺点。Over-The-Top(过顶位)技术目前主要用于ACL的翻修;时钟面定位法由于误差较大、稳定性差、可复性低,基本已不使用;骨性标志定位法(股骨外侧髁的住院医师嵴和分叉嵴、外侧髁后软骨缘顶点)由于解剖标志较为恒定,临床上多采用此法;X线透视下象限法由于术中实施较为繁琐,主要用于学术研究和术后骨道评估;计算机导航辅助骨道定位精确性高,避免了人为因素对骨道定位的影响,具有良好应用前景;3D打印辅助定位骨道技术定位精确,可复性高,学习曲线短。结论ACL重建术股骨骨道定位理念历经多次演变,反映了对ACL理解的深入和重建术临床效果的提高。定位技术的精确化、个性化和智能化是未来发展重点。

Objective To review the concept and methods of femoral bone tunnel positioning in anterior cruciate ligament(ACL)reconstruction,in order to provide a reference for clinical treatment.Methods The relevant literature on the concept and methods of femoral bone tunnel positioning in ACL reconstruction in domestic and international research was extensively reviewed.Results The position of the femoral bone tunnel is a key factor in determining the prognosis of ACL reconstruction.The concept of femoral bone tunnel positioning in ACL reconstruction has experienced isometric reconstruction,anatomical reconstruction,Ribbon-like theory,I.D.E.A.L.theory,and nearly isometric reconstruction theory.The femoral bone tunnel positioning technique is also changing with the in-depth study of the anatomy and biomechanics of the ACL,and each bone tunnel positioning technique has its own advantages and disadvantages.Over-The-Top technique is now mainly used for ACL revision;the clock-face positioning method is basically no longer applicable due to the large error,poor stability,and low retrievability;the bone landmarks positioning method(the lateral condyle of the femur’s Resident’s ridge and bifurcation ridge,and the the apex of the deep cartilage),which is now mostly used clinically due to the more constant anatomical landmarks.The quadrant method under X-ray fluoroscopy is more cumbersome to implement intraoperatively,so it is mainly used for academic research;computer navigation-assisted positioning has gradually become popular in recent years,which is highly accurate,avoids the influence of human factors on the positioning of the bone tunnel,and has a very good prospect of application;threedimensional printing-assisted positioning technology,which is accurate in positioning,with a high degree of reproducibility and a short learning curve.Conclusion The concept of femoral bone tunnel positioning for ACL reconstruction has undergone several evolutions,reflecting the deepening of the understanding of ACL and the improvement of the clinical results of reconstruction.The precision,personalization,and intelligence of positioning techniques are the focus of current and future development.