Singh A P, Singh B K
Department of Orthopaedics, Musgrove Park Hospital, Taunton, TA1 5DA, United Kingdom.
Knee. 2011 Dec;18(6):379-81. doi: 10.1016/j.knee.2010.10.008. Epub 2010 Nov 5.
Tunnel placement during anterior cruciate ligament reconstruction surgery is an important factor in determining the outcome of surgery. Tibial and femoral tunnel placement depends on the experience of the operating surgeon in order to achieve an isometric graft position. We performed a case series to study how often tunnel placement was adequate, as perceived by the surgeon, and if intra-operative image guidance could improve tunnel position. Over 3 years, a single surgeon and his team operated on 55 patients using single bundle patellar tendon bone or hamstring graft. The surgeon placed the guidewires where he felt they would achieve an isometric graft position. A transtibial jig was used for femoral tunnel positioning. At each step, the guidewires were checked using an image intensifier and repositioned as necessary. The number of times that the guidewire position could be improved using the image intensifier was documented. Follow up was between 1 to 3 years. The tibial guidewire was repositioned in 13 out of 55 cases and the femoral guidewire in 16 out of 55 cases. Forty-five out of 55 patients returned to their pre injury state. There were no cases of graft failure in the follow up period. The study concludes that tunnel placement is not always successful despite the surgeon's perception of adequate placement. The use of an intra-operative image intensifier can help the surgeon to achieve accurate and reproducible tunnel placement in ACL reconstruction surgery. We recommend this technique to all surgeons carrying out such procedures.
前交叉韧带重建手术中隧道的定位是决定手术效果的重要因素。胫骨和股骨隧道的定位取决于手术医生的经验，以实现移植物等长的位置。我们进行了一项病例系列研究，以探讨手术医生认为隧道定位足够准确的频率，以及术中图像引导是否可以改善隧道位置。在3年多的时间里，一名外科医生及其团队对55例患者进行了单束髌腱骨或腘绳肌移植物手术。外科医生将导丝放置在他认为能实现移植物等长位置的地方。使用经胫骨夹具进行股骨隧道定位。在每一步，使用影像增强器检查导丝并根据需要重新定位。记录使用影像增强器可改善导丝位置的次数。随访时间为1至3年。55例中有13例胫骨导丝重新定位，55例中有16例股骨导丝重新定位。55例患者中有45例恢复到受伤前状态。随访期间没有移植物失败的病例。该研究得出结论，尽管手术医生认为定位足够准确，但隧道定位并不总是成功的。术中使用影像增强器可帮助外科医生在ACL重建手术中实现准确且可重复的隧道定位。我们向所有进行此类手术的外科医生推荐这项技术。
