椭圆形骨道重建前交叉韧带股骨隧道的影像学研究  

Radiographic Study of the Modified Femoral Tunnels of Anterior Cruciate Ligament Reconstruction

作　　者：张腾[1] 胡晓青[1] 马勇[1] 赵逢源 张家豪[1] 敖英芳[1] Zhang Teng Hu Xiaoqing Ma Yong Zhao Fengyuan Zhang Jiahao Ao Yingfang(Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院运动医学研究所,北京100191

出　　处：《中国运动医学杂志》2017年第2期106-110,共5页Chinese Journal of Sports Medicine

摘　　要：目的:改良前交叉韧带(anterior cruciate ligament,ACL)解剖单束重建方法,使股骨止点形态更接近解剖,术后CT检查三维重建测量骨隧道位置、形态,观察对比研究股骨骨隧道变化。方法:2014年7月至2015年6月,共45例ACL断裂患者接受改良关节镜下微创ACL重建术治疗,应用较小直径的骨隧道钻钻制骨隧道,再用骨锉将骨隧道逐渐扩大并改良为椭圆形。所有手术由同一高年资术者完成。所有患者术后1周内行CT检查,导入MIMICS软件,将骨隧道进行三维重建并测量骨隧道截面长径、短径。应用四分法测量并评估股骨骨隧道的位置。结果:所有45例患者中,移植物均可通过椭圆形骨隧道,术中未出现骨隧道后壁破裂、血管神经损伤等并发症。依据不同调整方法(6调7、6调8、7调8),骨隧道截面长径测量值分别为8.34±0.52 mm、10.65±0.72 mm、9.27±0.11 mm,与理论值(8.16 mm、10.66 mm、9.14 mm)比较差异无统计学意义。而骨隧道截面短径测量值为6.57±0.12 mm、6.74±0.13 mm、7.52±0.05 mm,与理论值(6 mm、6 mm、7 mm)比较差异均有统计学意义。股骨骨隧道中心点位于股骨外髁长度的后26.4%±4.8%、高度的下30.1%±5.6%。结论:本研究通过改良ACL解剖单束重建,应用较小直径的骨隧道钻钻制骨隧道,再用骨锉将骨隧道逐渐扩大并改良为椭圆形。术后测量证实移植物与骨隧道良好匹配。CT三维重建测量骨隧道位置定位在ACL解剖止点范围内,骨隧道入口处形态更接近解剖。Objective To modify anterior cruciate ligament（ACL）reconstruction to achieve betterstructure;to measure the tunnel＇s position and shape using three-dimensional computed tomography（CT）so as to show the change of the femoral bony tunnel. Methods Forty-five patients were diagnosedwith an ACL tear and subsequently underwent the modified ACL reconstruction,using a minor-diameterdrill to drill the femoral tunnel and then expand it to oval-shaped tunnel with the raspatory betweenJuly 2014 and 2015. All procedures were conducted by the same experienced surgeon（Ao Yf.）. In allpatients,CT was performed at one week after the ACL reconstruction to evaluate the femoral tunnel＇spositioning,then the CT- images were imported into the image processing software MIMICS to recon-struct the femoral bony tunnel to measure the tunnel＇s diameters of the section and the shape. The tun-nel＇s position was evaluated using the quadrant method. Results In all the 45 patients,the graft couldpass the tunnel. And no posterior tunnel wall blowout,neurological or vascular deficit was documentedduring the operation. According to the different methods of modification（6 to 7,6 to 8 and 7 to 8）,the long diameters of the sections of the femoral bony tunnels were 8.34 ± 0.52 mm,10.65 ± 0.72 mm,9.27 ± 0.11 mm,without significant difference from the theoretical value（8.16 mm,10.66 mm and9.14 mm）. However,the short diameters of the sections were 6.57 ± 0.12 mm,6.74 ± 0.13 mm,and7.52 ± 0.05 mm,showing significant difference from the theoretical value（6mm,6mm and 7 mm）. Theaverage centre of the femoral tunnel was located at 26.4 ± 4.8% of the femoral length and at 30.1 ±5.6% of the femoral height. Conclusion In this modified ACL reconstruction,a minor-diameter drill isused to drill the femoral tunnel and then expand it to oval-shaped tunnel with the raspatory,The graftwas matched well with the bony tunnel intraoperatively. The three-dimensional CT shows that the femo-ral tunnels are well located within the anatomical A

关 键 词：前交叉韧带 解剖单束重建 椭圆形骨隧道 CT三维重建 

分 类 号：R687.4[医药卫生—骨科学] R816.8[医药卫生—外科学]