Lee Byung Hoon, Kum Dong Ho, Rhyu Im Joo, Kim Youngjun, Cho Hyunchul, Wang Joon Ho
Department of Orthopaedic Surgery, Kang-Dong Sacred Heart Hospital, Hallym University Medical Center, Gil-dong, Seoul, 134-701, South Korea.
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2016 Nov;24(11):3556-3564. doi: 10.1007/s00167-016-4332-6. Epub 2016 Oct 19.
To evaluate the clinical advantages of a navigation system developed with an emphasis on attaining an appropriate femoral tunnel length and posterior wall margin with no posterior wall blowout, as well as having accurate tunnel positioning, in anatomical anterior cruciate ligament reconstruction (ACLR).
Ten freshly frozen human knees were transected at mid-femur and mid-tibia. Each knee specimen underwent arthroscopic single-bundle anterior cruciate ligament reconstruction using the outside-in technique, with two knees by manual ACLR (control group) and another eight knees by only the navigational ACLR without arthroscopic assistance (experimental group). The position/orientation information of tunnel entry point, tunnel length, and posterior wall distance of pre-, intra-, and postoperative tunnel were recorded, and the reliability and errors among them were evaluated.
From comparison of the 3D models for preoperative planning and postoperative reconstruction, the mean differences for navigational femoral tunnelling and arthroscopic-assisted femoral tunnelling were recorded, respectively: (1) tunnel entry position, 1.4 mm (SD 0.3) versus 4.9 mm; (2) tunnel length, 0.7 mm (SD 0.2), similar to 0.6 mm in arthroscopic-assisted femoral tunnelling, and (3) posterior wall distance, 0.5 mm (SD 0.2), much smaller than 4.7 mm for arthroscopic-assisted femoral tunnelling. The intraclass correlation coefficients, calculated to determine the accuracy and reliability of navigational femoral tunnelling, showed excellent internal consistency that ranged from 0.965 to 0.989 for tunnel length and from 0.810 to 0.953 for posterior wall distance.
Navigation systems with enhancement of the registration accuracy by the developed system are feasible in anatomical ACLR, in reducing surgical failures such as short tunnel length or posterior wall breakage of distal femur. The present study revealed that computer navigation could aid in avoiding major mistakes in exact positioning and posterior wall blowout and help in attaining appropriate length for femoral tunnelling in anatomical ACLR.
评估一种导航系统在解剖学前交叉韧带重建（ACLR）中的临床优势，该系统着重于实现合适的股骨隧道长度和后壁边缘，避免后壁穿孔，并具有准确的隧道定位。
将10个新鲜冷冻的人膝关节在股骨和胫骨中部横断。每个膝关节标本采用由外向内技术进行关节镜下单束前交叉韧带重建，其中2个膝关节采用手动ACLR（对照组），另外8个膝关节仅采用导航ACLR且无关节镜辅助（实验组）。记录术前、术中和术后隧道的入口点位置、隧道长度和后壁距离的位置/方向信息，并评估它们之间的可靠性和误差。
通过比较术前规划和术后重建的三维模型，分别记录了导航股骨隧道和关节镜辅助股骨隧道的平均差异：（1）隧道入口位置，分别为1.4毫米（标准差0.3）和4.9毫米；（2）隧道长度，0.7毫米（标准差0.2），与关节镜辅助股骨隧道的0.6毫米相似；（3）后壁距离，0.5毫米（标准差0.2），远小于关节镜辅助股骨隧道的4.7毫米。为确定导航股骨隧道的准确性和可靠性而计算的组内相关系数显示出极好的内部一致性，隧道长度的范围为0.965至0.989，后壁距离的范围为0.810至0.953。
通过所开发系统提高配准精度的导航系统在解剖学ACLR中是可行的，可减少诸如隧道长度过短或股骨远端后壁破裂等手术失败情况。本研究表明，计算机导航有助于避免在精确位置和后壁穿孔方面的重大错误，并有助于在解剖学ACLR中获得合适的股骨隧道长度。
