Oshima Takeshi, Nakase Junsuke, Ohashi Yoshinori, Shimozaki Kengo, Asai Kazuki, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Ishikawa, Japan.
Knee. 2020 Jun;27(3):809-816. doi: 10.1016/j.knee.2020.02.017. Epub 2020 Mar 13.
Fluoroscopy and navigation systems provide an accurate and reproducible method of guiding anatomical tunnel positioning during anterior cruciate ligament reconstruction (ACLR). The aim was to evaluate the differences in tibial tunnel location assessed by both an intraoperative navigation system and fluoroscopy, validated using a one-week postoperative three-dimensional computed tomography (3DCT).
The tibial tunnel location in a consecutive series of 35 patients who received a single-bundle ACLR was evaluated by intraoperative navigation system, fluoroscopic image and compared with postoperative 3DCT position. The location to the anterior-posterior (AP) and medial-lateral (ML) direction were compared between all three methods.
The tibial tunnel locations were 46.7 ± 4.5%, 44.5 ± 1.9%, and 43.6 ± 2.4% in ML direction, and 42.8 ± 7.6%, 37.9 ± 3.8%, and 37.9 ± 3.7% in AP direction using an intraoperative navigation system, fluoroscopic image and postoperative 3DCT, respectively. Significant differences between the navigation system and fluoroscopic image (ML, P = 0.001; AP, P = 0.006), and the navigation system and 3DCT (ML, P = 0.001; AP, P < 0.001) were seen. However, there was no significant difference between fluoroscopy and 3DCT (ML, P = 0.315; AP, P = 0.999). There was a significant lack of agreement for analyses measured using a navigation system and 3DCT. Fluoroscopy and 3DCT demonstrated an acceptable agreement (ML, r = -0.21, P = 0.232; AP, r = 0.04, P = 0.826).
A tibial tunnel location assessed by intraoperative fluoroscopy shows better agreement and interchangeability with one-week postoperative 3DCT validation during single-bundle ACLR compared with an intraoperative image-free navigation system.
在进行前交叉韧带重建术（ACLR）时，荧光镜检查和导航系统为引导解剖隧道定位提供了一种准确且可重复的方法。本研究旨在评估术中导航系统和荧光镜检查所评估的胫骨隧道位置差异，并通过术后一周的三维计算机断层扫描（3DCT）进行验证。
对连续35例行单束ACLR患者的胫骨隧道位置，通过术中导航系统、荧光镜图像进行评估，并与术后3DCT位置进行比较。比较三种方法在前后（AP）和内外侧（ML）方向上的位置。
在ML方向上，使用术中导航系统、荧光镜图像和术后3DCT时，胫骨隧道位置分别为46.7±4.5%、44.5±1.9%和43.6±2.4%；在AP方向上，分别为42.8±7.6%、37.9±3.8%和37.9±3.7%。术中导航系统与荧光镜图像之间（ML，P = 0.001；AP，P = 0.006）以及术中导航系统与3DCT之间（ML，P = 0.001；AP，P < 0.001）存在显著差异。然而，荧光镜检查与3DCT之间无显著差异（ML，P = 0.315；AP，P = 0.999）。使用导航系统和3DCT进行测量分析时，一致性明显不足。荧光镜检查和3DCT显示出可接受的一致性（ML，r = -0.21，P = 0.232；AP，r = 0.04，P = 0.826）。
与术中无图像导航系统相比，在单束ACLR中，术中荧光镜检查评估的胫骨隧道位置与术后一周3DCT验证具有更好的一致性和互换性。
