两种股骨前交叉韧带重建骨隧道钻取技术的比较。
A comparison of 2 drilling techniques on the femoral tunnel for anterior cruciate ligament reconstruction.
机构信息
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia 22908, USA.
出版信息
Arthroscopy. 2011 Mar;27(3):372-9. doi: 10.1016/j.arthro.2010.08.012. Epub 2010 Nov 24.
PURPOSE
This cadaveric study was undertaken to characterize the femoral tunnel geometry resulting from commonly used drilling techniques in anterior cruciate ligament reconstruction.
METHODS
We randomized 10 matched-pair cadaveric knees (20 knees) into 2 groups with right and left matched pairs from each cadaver. Of the knees, 10 underwent transtibial femoral tunnel drilling from a far-medial starting point on the tibia (group 1) and 10 had the femoral tunnel drilled from a medial arthroscopic portal (group 2). The dimensions and size of the apertures, the volume and length of the tunnels, and the distance of the tunnels from the posterior wall and articular surface were measured by computed tomography.
RESULTS
The mean femoral tunnel length was 29.7 mm in group 1 and 15.7 mm in group 2. The mean volume for each tunnel was 2,401 mm(3) in group 1 and 2,071 mm(3) in group 2. The intra-articular aperture area was 94.6 mm(2) in group 1 and 98.6 mm(2) in group 2. In group 2 the intra-articular shape was more elliptical than in group 1, with the long axis averaging 13.5 ± 1.3 mm (P = .004) and short axis averaging 9.7 ± 1.0 mm (P = .002); in group 2 the long axis averaged 12.5 ± 1.7 and short axis averaged 10.3 ± 0.7 (P = .002). Group 2 was closer to the posterior wall and articular surface (6.9 ± 0.6 mm and 9.4 ± 0.6 mm, respectively) than group 1 (10.8 ± 1.0 mm and 11.8 ± 1.9 mm, respectively).
CONCLUSIONS
We determined the length and volume of the femoral tunnel to be shorter and smaller, respectively, with a medial arthroscopic portal. In addition, the aperture shape was more of an ellipse with a medial arthroscopic portal. The medial arthroscopic portal also created a femoral tunnel that was closer to the posterior wall and articular surface of the femur.
CLINICAL RELEVANCE
Improved characterization of osseous tunnels with 3-dimensional figures will allow for improved matching of graft and incorporation.
目的
本尸体研究旨在描述前交叉韧带重建中常用的钻孔技术导致的股骨隧道几何形状。
方法
我们将 10 对配对的尸体膝关节（20 个膝关节）随机分为 2 组，每组各有 5 对右侧和左侧配对膝关节。其中 10 个膝关节经胫骨远内侧起点行胫骨隧道钻孔（组 1），10 个膝关节经内侧关节镜入路行股骨隧道钻孔（组 2）。通过计算机断层扫描测量隧道的孔径尺寸和大小、隧道的容积和长度以及隧道距股骨后壁和关节面的距离。
结果
组 1 的股骨隧道平均长度为 29.7mm，组 2 的股骨隧道平均长度为 15.7mm。组 1 每个隧道的平均容积为 2401mm³，组 2 每个隧道的平均容积为 2071mm³。组 1 的关节内孔径面积为 94.6mm²，组 2 的关节内孔径面积为 98.6mm²。组 2 的关节内形态比组 1 更呈椭圆形，长轴平均为 13.5±1.3mm（P=0.004），短轴平均为 9.7±1.0mm（P=0.002）；组 2 的长轴平均为 12.5±1.7mm，短轴平均为 10.3±0.7mm（P=0.002）。组 2 更接近股骨后壁和关节面（分别为 6.9±0.6mm 和 9.4±0.6mm），而组 1 则分别为 10.8±1.0mm 和 11.8±1.9mm（P=0.002）。
结论
我们发现，经内侧关节镜入路钻孔时，股骨隧道的长度和容积分别较短和较小。此外，经内侧关节镜入路钻孔时，孔径形状更呈椭圆形。内侧关节镜入路还可使股骨隧道更靠近股骨后壁和关节面。
临床意义
通过三维图像更好地描述骨性隧道，可以更好地匹配移植物和植入物。
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