Taketomi Shuji, Inui Hiroshi, Nakamura Kensuke, Hirota Jinso, Takei Seira, Takeda Hideki, Tanaka Sakae, Nakagawa Takumi
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Arthrosc Tech. 2012 Jun 15;1(1):e95-9. doi: 10.1016/j.eats.2012.04.003. Print 2012 Sep.
Revision anterior cruciate ligament (ACL) reconstruction is accompanied by several technical challenges that must be addressed, such as a primary malpositioned bone tunnel, pre-existing hardware, or bone defects due to tunnel expansion. We describe a surgical technique used to create an anatomic femoral socket using a 3-dimensional (3D) fluoroscopy-based navigation system in technically demanding revision cases. After a reference frame is rigidly attached to the femur, an intraoperative image of the distal femur is obtained, which is transferred to a navigation system and reconstructed into a 3D image. A navigation computer helps the surgeon to visualize the whole image of the lateral wall of the femoral notch, even if the natural morphology of the intercondylar notch has been destroyed by the primary procedure. In addition, the surgeon can also confirm the position of the previous bone tunnel aperture, the previous exit of the femoral tunnel, and the presence of any pre-existing hardware on the navigation monitor. When a new femoral guidewire for the revision procedure is placed, the virtual femoral tunnel is overlaid on the reconstructed 3D image in real time. At our institution, 12 patients underwent 1-stage revision ACL procedures with the assistance of this computer navigation system, and the grafts were securely fixed in anatomically created tunnels in all cases. This technology can assist surgeons in creating anatomic femoral tunnels in technically challenging revision ACL reconstructions.
前交叉韧带（ACL）翻修重建手术面临着一些必须解决的技术挑战，比如初次手术时骨隧道位置不佳、原有内植物，或者由于隧道扩大导致的骨缺损。我们描述了一种在技术要求较高的翻修病例中，使用基于三维（3D）透视的导航系统创建解剖学股骨髁间窝的手术技术。在将参考架牢固地固定在股骨上后，获取股骨远端的术中图像，并将其传输至导航系统，重建为三维图像。即使髁间窝的自然形态已被初次手术破坏，导航计算机也能帮助外科医生可视化股骨髁间窝外侧壁的全貌。此外，外科医生还可以在导航监视器上确认先前骨隧道开口的位置、股骨隧道的先前出口以及任何原有内植物的存在情况。在进行翻修手术放置新的股骨导丝时，虚拟股骨隧道会实时叠加在重建的三维图像上。在我们机构，12例患者在该计算机导航系统的辅助下接受了一期ACL翻修手术，所有病例中移植物均牢固地固定在解剖学创建的隧道内。这项技术可帮助外科医生在技术上具有挑战性的ACL翻修重建手术中创建解剖学股骨隧道。
