负荷条件下前交叉韧带胫骨重建位置的等距特性

Isometric Feature of Tibial Tunnel Position for ACL Reconstruction Under Load Condition

【目的】探讨模拟生理负荷条件下前交叉韧带胫骨重建位置的等距特性。【方法】7具新鲜冷冻尸体膝关节标本 ,在前交叉韧带胫骨附着区取 5点以及股骨附着区中点分别钻骨隧道 ,通过钢丝和等距测量器施加初负荷 ,检测膝关节屈曲过程中胫骨和股骨隧道间的距离变化。【结果】膝关节从 0°～ 90°屈曲过程中 ,胫骨韧带附着区中点、后点、内点和外点与股骨附着区中点间距离呈等距变化 ,而胫骨韧带附着区前点与股骨附着区中点间距离变化超过生理等距界限 ,但胫骨韧带附着区中点、内点和外点与股骨附着区中点间距离最大变化值均超过 2mm。【结论】胫骨韧带附着区后点是前交叉韧带理想的等距重建点。

[Objectives]To explore the isometric feature of tibial tunnel position for anterior cruciate ligament ( ACL ) reconstruction under a physiologically simulated load condition.Knee specimens from seven fresh-frozen cadavers were used. Bone tunnels were drilled at five points of ACL's tibial insertion and the central point of femoral insertion, respectively. Initial load was exerted by wire and isometer. The changes in distance separated between tibial and femoral tunnels were measured during passive knee flexion-extension.For the middle, medial, lateral and posterior points of ACL's insertion on tibia, the mean change in distance separated between each of them on tibia and the central point of femoral insertion was absolutely isometric when the knee was flexed from 0° to 90°, but the maximal length changes in former three points were all over 2.0 mm; whereas the change in distance between the anterior point of ligament insertion on tibia and the central point of femoral insertion rather exceeded physiological isometry.[Conclusion]Our data support the concept that the posterior point of the ACL's tibial insertion is optimal position for ACL's isometric reconstruction.