椭圆形骨道重建前交叉韧带股骨隧道的影像学研究

发布时间：2018-11-07 08:41

【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。
[Abstract]:Objective: to improve the method of single bundle reconstruction of anterior cruciate ligament (anterior cruciate ligament,ACL), to make the femoral insertion closer to anatomy, and to measure the position and shape of bone tunnel by three-dimensional reconstruction with CT after operation, and to observe and compare the changes of femoral bone tunnel. Methods: from July 2014 to June 2015, 45 patients with ACL rupture were treated with modified arthroscopic minimally invasive ACL reconstruction. Small diameter bone tunnels were drilled to make bone tunnels, and bone tunnels were gradually expanded and improved to ellipse with bone file. All operations were performed by the same high-age person. All the patients were examined by CT within 1 week after operation. The bone tunnel was reconstructed by MIMICS software and the length and short diameter of bone tunnel cross-section were measured. The location of femoral bone tunnel was measured and evaluated by quadrant method. Results: in all 45 patients, the grafts could pass through the oval bone tunnel, and there were no complications such as the rupture of the posterior wall of the bone tunnel and the injury of blood vessel and nerve. According to different adjustment methods (6, 7, 7, 8, 8), the measured values of cross-section length of bone tunnel were 8.34 卤0.52 mm,10.65 卤0.72 mm,9.27 卤0.11 mm, and (8.16 mm,10.66 mm,), respectively. There was no significant difference in 9. 14 mm. The short diameter of bone tunnel section was 6.57 卤0.12 mm,6.74 卤0.13 mm,7.52 卤0. 05 mm, which was significantly different from the theoretical value (6 mm,6 mm,7 mm). The central point of the femoral bone tunnel was 26.4% 卤4.8 of the length of the lateral femoral condyle and 30.1% 卤5.6of the height of the femur. Conclusion: in this study, the bone tunnel was drilled by using a small diameter bone tunnel to reconstruct the bone tunnel by modified ACL anatomical single bundle, and then the bone tunnel was gradually expanded and improved to ellipse by using bone file. CT 3D reconstruction showed that the position of bone tunnel was located within the range of ACL anatomic stop and the shape of the entrance of bone tunnel was closer to anatomy.
【作者单位】：北京大学第三医院运动医学研究所;
【分类号】：R687.4;R816.8

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