Ahn Jin Hwan, Lee Yong Seuk, Ko Taeg Su, Shin Joung Youp
Orthopedics. 2016 Nov 1;39(6):e1085-e1091. doi: 10.3928/01477447-20160719-08. Epub 2016 Jul 27.
The purpose of this study was to compare the accuracy and reproducibility of the femoral tunnel location among 3 different viewing techniques used during outside-in anterior cruciate ligament (ACL) reconstruction with 3- dimensional (3-D) computed tomography (CT): (1) an anterolateral (AL) or anteromedial (AM) portal with a 30° arthroscope (A group) vs (2) a posterolateral (PL) portal with a 70° arthroscope (PL group) vs (3) a trans-septal (TS) portal with a 30° arthroscope (TS group). A total of 106 patients undergoing outside-in ACL reconstruction were recruited. Patients were divided into 3 groups according to viewing technique (A group=36 patients; PL group=35 patients; TS group=35 patients). Femoral tunnel locations were evaluated with the quadrant method and the anatomic coordinate axes measurement (ACAM) method in the medial wall of the lateral femoral condyle using 3-D reconstructed CT. The accuracy and reproducibility of the femoral tunnel locations were compared among the 3 techniques. The accuracy of the tunnel location was higher in the TS group by the quadrant method as well as the ACAM method. The reproducibility of the femoral tunnel position in the TS group was the highest, and the femoral tunnel locations of the TS group were more compactly distributed compared with those of the A and PL groups. The accuracy and reproducibility of the femoral tunnel location could be improved with a TS portal viewed using a 30° arthroscope. Anteromedial/anterolateral and PL portals viewed using a 70° arthroscope showed no difference. [Orthopedics. 2016; 39(6):e1085-e1091.].
本研究旨在比较在采用三维（3-D）计算机断层扫描（CT）的由外向内前交叉韧带（ACL）重建术中，3种不同观察技术在股骨隧道定位方面的准确性和可重复性：（1）使用30°关节镜的前外侧（AL）或前内侧（AM）入路（A组）与（2）使用70°关节镜的后外侧（PL）入路（PL组）与（3）使用30°关节镜的经间隔（TS）入路（TS组）。共招募了106例行由外向内ACL重建术的患者。根据观察技术将患者分为3组（A组 = 36例患者；PL组 = 35例患者；TS组 = 35例患者）。使用3-D重建CT，采用象限法和解剖坐标轴测量（ACAM）法评估股骨外侧髁内侧壁的股骨隧道位置。比较3种技术在股骨隧道定位方面的准确性和可重复性。采用象限法和ACAM法时，TS组的隧道定位准确性更高。TS组股骨隧道位置的可重复性最高，与A组和PL组相比，TS组的股骨隧道位置分布更集中。使用30°关节镜经TS入路可提高股骨隧道定位的准确性和可重复性。使用70°关节镜观察的前内侧/前外侧和PL入路无差异。[《骨科学》。2016年；39(6):e1085 - e1091。]
