双束 ACL 重建中隧道位置对 ACL 移植物力的生物力学影响——三维计算模拟。
The biomechanical effect of tunnel placement on ACL graft forces in double-bundle ACL reconstruction - A 3D computational simulation.
机构信息
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Massachusetts, USA.
Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
出版信息
Int J Med Robot. 2017 Dec;13(4). doi: 10.1002/rcs.1840. Epub 2017 Jun 1.
BACKGROUND
The posterolateral (PL) graft experiences a high failure rate in anterior cruciate ligament double-bundle (DB) reconstruction. It is hypothesized that tunnel positions could dramatically affect the graft forces.
METHODS
A validated computational model was used to simulate DB reconstruction with various femoral PL tunnel locations (8-11 mm center-center tunnel spacing). Graft fixation was simulated at both 0° and 30°. Knee biomechanics were examined with the knee under a 134 N anterior load and 400 N quadriceps load at 0°, 30°, 60°, and 90° of flexion. Graft forces, tibial translation, and tibial rotation were calculated.
RESULTS
PL graft forces at full extension increased with increasing tunnel spacing under both fixation settings, but the knee kinematics was not dramatically affected.
CONCLUSION
Small changes in the femoral PL tunnel position could result in large changes in graft forces, implying that precise PL tunnel position is an important factor in a successful DB reconstruction.
背景
后外侧（PL）移植物在前交叉韧带双束（DB）重建中失败率较高。有人假设隧道位置可能会极大地影响移植物的受力。
方法
使用经过验证的计算模型模拟了具有不同股骨 PL 隧道位置（8-11 毫米中心-中心隧道间距）的 DB 重建。在 0°和 30°分别模拟了移植物的固定。在 0°、30°、60°和 90°的膝关节屈伸运动下，在 134N 的前向负荷和 400N 的股四头肌负荷下检查了膝关节生物力学。计算了移植物的受力、胫骨平移和胫骨旋转。
结果
在两种固定设置下，随着隧道间距的增加，PL 移植物在完全伸展时的受力增加，但膝关节运动学并没有受到显著影响。
结论
股骨 PL 隧道位置的微小变化可能导致移植物受力的显著变化，这表明精确的 PL 隧道位置是 DB 重建成功的重要因素。
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