Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
Bone Joint Res. 2012 Oct 1;1(10):234-7. doi: 10.1302/2046-3758.110.2000086. Print 2012 Oct.
Our aim was to assess the use of intra-operative fluoroscopy in the assessment of the position of the tibial tunnel during reconstruction of the anterior cruciate ligament (ACL).
Between January and June 2009 a total of 31 arthroscopic hamstring ACL reconstructions were performed. Intra-operative fluoroscopy was introduced (when available) to verify the position of the guidewire before tunnel reaming. It was only available for use in 20 cases, due to other demands on the radiology department. The tourniquet times were compared between the two groups and all cases where radiological images lead to re-positioning of the guide wire were recorded. The secondary outcome involved assessing the tibial interference screw position measured on post-operative radiographs and comparing with the known tunnel position as shown on intra-operative fluoroscopic images.
Of the 20 patients treated with fluoroscopy, the imaging led to repositioning of the tibial guide wire before reaming in three (15%). The mean tourniquet time with intra-operative fluoroscopy was 56 minutes (44 to 70) compared with 51 minutes (42 to 67) for the operations performed without. Six patients (30%) had post-operative screw positions that were > 5% more posterior than the known position of the tibial tunnel.
Intra-operative fluoroscopy can be effectively used to improve the accuracy of tibial tunnel positions with minimal increase in tourniquet time. This study also demonstrates the potential inaccuracy associated with plain radiological assessment of tunnel position.
本研究旨在评估术中透视在评估前交叉韧带（ACL）重建时胫骨隧道位置中的应用。
2009 年 1 月至 6 月，共进行了 31 例关节镜下腘绳肌腱 ACL 重建术。术中透视（如可获得）用于在隧道扩孔前验证导丝的位置。由于放射科的其他需求，仅在 20 例中可使用透视。比较了两组的止血带时间，并记录了所有因影像学图像而导致导丝重新定位的病例。次要结果涉及评估术后 X 线片上胫骨干扰钉的位置，并与术中透视图像上显示的已知隧道位置进行比较。
在接受透视治疗的 20 例患者中，影像学检查导致 3 例（15%）在扩孔前重新定位胫骨导丝。透视组的平均止血带时间为 56 分钟（44 至 70 分钟），而未透视组的平均止血带时间为 51 分钟（42 至 67 分钟）。6 例（30%）患者术后螺钉位置比已知的胫骨隧道位置向后偏移超过 5%。
术中透视可有效提高胫骨隧道位置的准确性，同时可轻微增加止血带时间。本研究还表明，隧道位置的普通 X 线评估可能存在不准确。
