Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Department of BioMedical Engineering, Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.
Arthroscopy. 2018 Jan;34(1):144-151. doi: 10.1016/j.arthro.2017.08.308. Epub 2017 Dec 2.
To provide a quantitative guide to tunnel placement concurrently through the femur and acetabulum during a ligamentum teres reconstruction, minimizing the risk of injury to the obturator neurovascular bundle.
Nine human cadaveric pelvises, complete with femurs (mean age, 59.6 years; age range, 47-65 years), were studied. Before dissection, a 3-dimensional coordinate-measuring device was used to record the neutral orientation of the femur in the acetabulum. The specimens were then dissected free of all extra-articular soft tissue, except for the ligamentum teres and the obturator neurovascular bundle, and digitized. An anatomic femoral reconstruction tunnel through the femoral neck was simulated and extended along its axis into the acetabulum. The femur was digitally rotated internally from 0° to 30° and externally from 0° to 40°, as well as abducted from 0° to 30° and adducted from 0° to 20°, in increments of 1°. At each position, the location of the simulated acetabular reconstruction tunnel was measured with respect to the obturator bundle and the edge of the acetabular fossa.
The anatomic reconstruction tunnel entered the lateral side of the femur at a mean distance of 7.0 mm distal and 5.8 mm anterior to the center of the vastus ridge. By angling the femur at 15° of internal rotation and 15° of abduction, the obturator neurovascular bundle was avoided in 100% of specimens.
The most important finding of this study was that a ligamentum teres reconstruction tunnel could be reamed through the femoral neck and safely positioned in the acetabulum by angling the femur at 15° of internal rotation and 15° of abduction.
These quantitative descriptions of the ligamentum teres reconstruction tunnels can be used to guide arthroscopic surgical interventions designed to address ligamentum teres pathology.
提供一种定量指南，指导在进行圆韧带重建时同时穿过股骨和髋臼的隧道，将闭孔神经血管束损伤的风险降到最低。
研究了 9 具完整的人尸体骨盆，包括股骨（平均年龄 59.6 岁；年龄范围 47-65 岁）。在解剖前，使用三维坐标测量设备记录股骨在髋臼中的中立位取向。然后将标本从所有关节外软组织中解剖出来，除了圆韧带和闭孔神经血管束，并对其进行数字化处理。模拟经股骨颈的解剖重建隧道，并沿着其轴延伸至髋臼。股骨分别在内旋 0°至 30°和外展 0°至 40°以及外展 0°至 30°和内收 0°至 20°的情况下，以 1°的增量数字化旋转。在每个位置，测量模拟髋臼重建隧道相对于闭孔神经血管束和髋臼窝边缘的位置。
解剖重建隧道进入股骨的外侧，距离股直肌嵴中心远端 7.0mm，前方 5.8mm。通过股骨内旋 15°和外展 15°，在 100%的标本中避开了闭孔神经血管束。
本研究的最重要发现是，通过股骨颈扩髓并使股骨内旋 15°和外展 15°，可以安全地将圆韧带重建隧道定位在髋臼中。
这些圆韧带重建隧道的定量描述可用于指导旨在解决圆韧带病变的关节镜手术干预。
