髁间窝外侧壁后软骨缘顶点辅助定位前交叉韧带股骨骨道  

The Apex of the Deep Cartilage as a Landmark for Femoral Tunnel Drilling during Anterior Cruciate Ligament Reconstruction

作　　者：马勇[1] 蒋艳芳[1] 王海军[1] 王永健[1] 王健[1] 林霖[1] 刘阳[1] 余家阔[1] 敖英芳[1] Ma Yong;Jiang Yanfang;Wang Haijun;Wang Yongjian;Wang Jian;Lin Lin;Liu Yang;Yu Jiakuo;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》2018年第7期553-557,共5页Chinese Journal of Sports Medicine

摘　　要：目的:通过术后CT评估,观察髁间窝外侧壁后软骨缘顶点(the apex of the deep cartilage,ADC)辅助定位前交叉韧带(anterior cruciate ligament,ACL)股骨骨道位置的解剖特点。方法:2014年7月至2016年7月,关节镜下ACL重建患者58例。术中屈膝120°,廓清髁间窝外侧壁暴露ADC。以ADC为参照,用off center为5~6 mm的股骨定位器辅助确定股骨骨道中心点的位置,继而制作股骨骨道。术后在CT上测量ADC至前骨缘的水平距离(L_a)以及与骨道中心点的水平距离(l_a),计算l_a/L_a的比值(Pa),同时测量骨道中心点与下骨缘的距离(D_a)。将此结果与36例残端中心定位的CT评估结果做比较(相应标记为L_b,l_b,P_b及D_b)。符合正态分布数据采用独立样本t检验,非正态分布数据采用Mann-Whitney检验。结果:Pa平均值为44.1%(41.1%~49.5%),Pb平均值为44.9%(40.9%~50.2%)(P=0.083)。Da平均值为6.3mm(5~7.6 mm),D_b=6.3 mm(5.1~7.5 mm)(P=0.833)。结论:以ADC为标志,使用off center股骨定位器直接高屈膝位定位ACL股骨骨道,可获得与残端定位相似的位置。Objective To evaluate the femoral tunnel position at the anterior cruciate ligament（ACL）reconstruction using the apex of the deep cartilage（ADC） as a Landmark by CT scan. Methods A to-tal of 58 patients undergoing the anatomic arthroscopic ACL reconstruction in our institute betweenMay 2014 and 2016 were selected. During the operation,the knee was flexed at 120°,and the lateralwall of the intercondylar notch was debrided to expose ADC. The center of the femoral tunnel was es-tablished using a 5～6 mm aimer,with the help of which the distance from the ADC was estimated. Onthe post-operative CT scan,the distances from the ADC to the anterior cartilage margin（La） and to thecenter of femoral tunnel（la）,as well as the distance from the center to the distal cartilage margin（Da）were measured. The ratio of la/La was calculated（Pa）. These results were compared to those derivedfrom 36 patients undergoing ACL reconstruction using the center of the insertion for femoral tunnel po-sitioning（Lb,lb,Pb and Db respectively）. Data of normal distribution were compared with t-test whilethose not normally distributed were analyzed using the Mann-Whitney test. Results The average Pawas44.1%（ranging from 41.1% to 49.5%） and Pbof 44.9%（ranging from 40.9% to 50.2%）（P=0.083）. Theaverage Dawas 6.3 mm（5～7.6 mm） while Dbwas 6.3 mm（5.1～7.5 mm）（P=0.833）. Conclusions ACLreconstruction using the apex of the deep cartilage as a landmark for femoral tunnel drilling canachieve a similar tunnel position to that using the center of the insertion as an anatomic landmark.

关 键 词：前交叉韧带 股骨骨道 后软骨缘顶点 CT 

分 类 号：R687.4[医药卫生—骨科学]