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本文引用的文献

1
Deterioration of stress distribution due to tunnel creation in single-bundle and double-bundle anterior cruciate ligament reconstructions.由于单束和双束前交叉韧带重建术中隧道的创建，导致应力分布恶化。
Ann Biomed Eng. 2012 Jul;40(7):1554-67. doi: 10.1007/s10439-012-0517-4.
2
Tunnel widening after anterior cruciate ligament reconstruction: a prospective randomized computed tomography--based study comparing 2 different femoral fixation methods for hamstring graft.前交叉韧带重建术后隧道增宽：一项基于前瞻性随机 CT 比较 2 种不同股骨髓内固定方法的腘绳肌腱移植物的研究。
Arthroscopy. 2011 Jun;27(6):776-83. doi: 10.1016/j.arthro.2011.02.009.
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Tunnel widening in revision anterior cruciate ligament reconstruction.翻修前交叉韧带重建术中隧道增宽。
J Am Acad Orthop Surg. 2010 Nov;18(11):695-706. doi: 10.5435/00124635-201011000-00007.
4
Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up.前交叉韧带重建后膝关节功能和膝骨关节炎的患病率：一项 10 至 15 年随访的前瞻性研究。
Am J Sports Med. 2010 Nov;38(11):2201-10. doi: 10.1177/0363546510373876. Epub 2010 Aug 16.
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Loading of the knee joint during activities of daily living measured in vivo in five subjects.在 5 名受试者中进行的日常生活活动中的膝关节加载的体内测量。
J Biomech. 2010 Aug 10;43(11):2164-73. doi: 10.1016/j.jbiomech.2010.03.046.
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Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction.胫骨钻孔角度对前交叉韧带重建中骨隧道孔径的影响。
J Bone Joint Surg Am. 2010 Apr;92(4):871-81. doi: 10.2106/JBJS.H.01680.
7
Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart.解剖学单束和双束前交叉韧带重建流程图。
Arthroscopy. 2010 Feb;26(2):258-68. doi: 10.1016/j.arthro.2009.07.027.
8
Multi-factorial analysis of variables influencing the bone loss of an implant placed in the maxilla: prediction using FEA and SED bone remodeling algorithm.多因素分析影响上颌种植体骨丢失的变量：使用有限元分析和 SED 骨重塑算法进行预测。
J Biomech. 2010 Mar 3;43(4):644-51. doi: 10.1016/j.jbiomech.2009.10.030. Epub 2009 Nov 25.
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Differences in tendon graft healing between the intra-articular and extra-articular ends of a bone tunnel.骨隧道关节内和关节外端的肌腱移植物愈合的差异。
HSS J. 2009 Feb;5(1):51-7. doi: 10.1007/s11420-008-9096-1. Epub 2008 Dec 4.
10
Tibial aperture bone disruption after retrograde versus antegrade tibial tunnel drilling: a cadaveric study.逆行与顺行胫骨隧道钻孔后胫骨骨孔骨破坏的尸体研究
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解剖单束前交叉韧带重建术后胫骨钻孔导向角度对骨隧道开口处力学环境的影响

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction.

作者信息

Yao Jie, Wen Chun Yi, Zhang Ming, Cheung Jason Tak-Man, Yan Chunhoi, Chiu Kwong-Yuen, Lu William Weijia, Fan Yubo

机构信息

National Key Lab of Virtual Reality Technology, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, China.

出版信息

Int Orthop. 2014 May;38(5):973-81. doi: 10.1007/s00264-014-2290-5. Epub 2014 Feb 25.

DOI:10.1007/s00264-014-2290-5
PMID:24566992
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3997784/
Abstract

PURPOSE

The tibial drill-guide angle in anterior cruciate ligament (ACL) reconstruction influences the tunnel placement and graft-tunnel force, and is potentially associated with post-operative tunnel widening. This study aimed to examine the effect of the drill-guide angle on the stress redistribution at the tibial tunnel aperture after anatomic single-bundle ACL reconstruction.

METHODS

A validated finite element model of human knee joint was used. The tibial tunnel with drill-guide angle ranging from 30° to 75° was investigated. The post-operative stress redistribution in tibia under the compressive, valgus, rotational and complex loadings was analysed.

RESULTS

Compressive loading played a leading role on the stress redistribution at intra-articular tibial tunnel aperture. After ACL reconstruction, stress concentration occurred in the anterior and posterior regions of tunnel aperture while stress reduction occurred in the lateral and posteromedial regions under the compressive loading. Stress redistribution was partially alleviated by using the drill-guide angle ranging from 55° to 65°.

CONCLUSIONS

The present study quantified the effect of bone tunnel drill-guide angle on the post-operative stress redistribution. This phenomenon potentially contributed to tunnel widening. A tunnel drill-guide angle ranging from 55° to 65° was proposed based on the biomechanical rationale. It could serve as a helpful surgical guide for ACL reconstruction.

摘要

目的

前交叉韧带（ACL）重建术中胫骨钻孔导向角度会影响隧道位置和移植物-隧道受力，且可能与术后隧道增宽有关。本研究旨在探讨解剖单束ACL重建术后钻孔导向角度对胫骨隧道开口处应力再分布的影响。

方法

使用经过验证的人体膝关节有限元模型。研究了钻孔导向角度范围为30°至75°的胫骨隧道。分析了在压缩、外翻、旋转和复合载荷下胫骨术后的应力再分布情况。

结果

压缩载荷在关节内胫骨隧道开口处的应力再分布中起主导作用。ACL重建后，在压缩载荷下，隧道开口的前部和后部出现应力集中，而外侧和后内侧区域出现应力降低。使用55°至65°的钻孔导向角度可部分缓解应力再分布。

结论

本研究量化了骨隧道钻孔导向角度对术后应力再分布的影响。这种现象可能导致隧道增宽。基于生物力学原理，提出了55°至65°的隧道钻孔导向角度范围。它可为ACL重建提供有益的手术指导。