术中透视优化前交叉韧带重建术中股骨骨道定位的效果分析

Effects of intraoperative fluoroscopy to optimize femoral tunnel position in anterior cruciate ligament reconstruction

目的:比较前交叉韧带(anterior cruciate ligament,ACL)断裂进行解剖重建手术中,采用透视方法定位骨道位置前、后股骨骨道的分布情况。方法:2019年7月至2022年6月,收集在我科进行关节镜下ACL单束解剖重建手术的患者46例,其中男34例,女12例,左膝27例,右膝19例,平均年龄31.8±4.9岁。股骨骨道初次定位时依据术者经验进行定位,然后根据透视结果调整股骨侧骨道的定位位置。在股骨侧位视图上绘制矩形框,根据骨道中心点在此矩形框的深-浅方向及高-低方向上所占比例而定位骨道位置,比较初次定位及透视定位后,股骨骨道位置在各方向的分布情况及骨道位置良好程度。结果:透视定位前、后骨道位置在x轴情况:偏后7例调整为4例(9%),正常29例调整为36例(78%),偏前10例调整为6例(13%);y轴情况:偏高30例调整为19例(41%),正常14例调整为27例(59%),偏低2例调整为0例(0%)。初次定位时股骨骨道位置良好11例(24%),透视定位调整后骨道位置良好25例(54%)。结论:ACL单束解剖重建手术中,采用术中透视进行股骨骨道定位,有助于改善股骨侧骨道位置分散情况。

ObjectiveTo compare the distribution of femoral osseous tunnels between using the empirical and fluoroscopic methods during anatomical reconstruction surgery for anterior cruciate ligament(ACL)rupture.MethodsBetween July 2019 and June 2022,46 patients who underwent arthroscopic ACL single-bundle anatomical reconstruction in our department were enrolled,including 34 males and12 females,with 27 left and 19 right affected knees and a mean age of 31.8±4.9 years.The initial positioning of the femoral tunnel was based on the operator's experience,and later adjusted using the fluoroscopy.A rectangular box was drawn on the lateral view of the femoral tunnel,and the position of the tunnel was determined according to the proportion of the center of the tunnel in the deep-shallow and the high-low directions.Then,the distribution of the femoral tunnel position in each direction and the degree of good positioning were compared between the initial and fluoroscopic localizations.ResultsIn the initial localization,in the x-axis direction,7 were too left,29 were correct and 10 were too right,with the corresponding number being 4,36 and 6 using the fluoroscopic localization.Moreover,in the y-axis direction,30 and 3 cases were too high or too lower,with 14 norms using empirical method,while the numbers were 19,0 and 27 using the fluoroscopic positioning.The femoral tunnel was well-positioned in 11 cases(24%)at the time of initial positioning,and in 25 cases(54%)after fluoroscopic positioning adjustment.ConclusionThe use of intraoperative fluoroscopy helps to improve the dispersion of the femoral osseous tunnel position in ACL single-bundle anatomical reconstruction surgery.