Lee Sang Hyuk, Choi Jun Young, Kim Dong Hee, Kang Bun Jung, Nam Dae Cheol, Yoon Hong Kwon, Hwang Sun Chul
Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
Department of Thoracic and Cardiovascular Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
Yonsei Med J. 2014 Nov;55(6):1592-9. doi: 10.3349/ymj.2014.55.6.1592.
The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees.
The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured.
In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel.
The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.
本研究的目的是确定在使用人体尸体膝关节进行双束前交叉韧带（ACL）重建时，防止股骨骨隧道相通所需的前内侧（AM）和后外侧（PL）导丝隧道位置的最短可能距离。
用导丝钻取16具尸体膝关节股骨AM束和PL束的中心，并在导丝进入骨内时测量其距离。采用经皮技术进行股骨隧道钻孔。AM移植物和PL移植物的直径分别为8mm和6mm。对每个膝关节进行CT扫描，并构建三维模型以确定股骨隧道位置并创建AM和PL隧道虚拟圆柱体。测量两个隧道之间骨桥的厚度。
在六具标本中有四具，导丝放置距离小于或等于9mm时，发现有隧道相通。在导丝放置距离大于或等于10mm的标本中，未发现隧道相通。两组之间存在统计学显著差异（p = 0.008）。在AM和PL股骨隧道导丝之间的距离为12mm的情况下，沿隧道的骨桥厚度大于2mm。
我们在此展示的双束前交叉韧带（DB-ACL）重建技术，当AM和PL股骨导丝相距至少10mm放置时可避免骨隧道相通，应保持12mm的距离以保留2mm的骨桥厚度。
