前交叉韧带重建位置需个体化

Customize the position of anterior cruciate ligament reconstruction

目的 探讨模拟生理负荷条件下前交叉韧带的等距重建位置是否适用于每一个体。方法 7具新鲜冷冻尸体膝关节标本 ,在前交叉韧带股骨与胫骨附着区各取 5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 股骨韧带附着区中点、后点和下点与胫骨附着区 5点间的距离变化保持在等距范围内。膝关节自 0°屈曲至 90°位点间距离变化在各个标本间的差异无显著性。股骨韧带附着区中点、前点、上点和下点随膝关节屈曲分别在各膝关节间出现的差异有显著性。结论 股骨韧带附着区内重建位置变化影响重建疗效 ,股骨韧带附着区后点和下点是前交叉韧带重建的理想等距位点 ,前交叉韧带重建时应个体化调整重建位置。

Objective To investigate whether the isometric position is eligible in each knee for anterior cruciate ligament ( ACL ) reconstruction under physiological load mimicry. Methods Seven fresh-frozen cadaver knees were used. Five bone tunnels were drilled at ACL's tibial and femoral insertions, respectively. The initial load was made by wire and isometer. The changes in the distancess between tibial and femoral tunnels were measured during passive knee flexion-extension. Results The mean changes in the distancs between each of the central, posterior and inferior positions within the femoral insertion of the ACL and each of the five positions in the tibial insertion were isometric. There was no significant difference in all specimens as the knee was flexed from 0 degree to 90 degrees. The central, anterior, superior and inferior femoral positions were significantly different from knee to knee as the knee was flexed at 15 degrees increments, respectively. Conclusions The change of reconstruction position in the femoral insertion is responsible for the success of intraarticular reconstruction of the ACL. The posterior and inferior positions in the femoral insertion are the optimal isometric graft positions for ACL reconstruction. Customizing the graft position in each knee is reguired at the time of surgery.