双束腘绳肌腱重建前交叉韧带后股骨隧道增宽导致隧道在前侧和远侧方向的位置发生小的移位：基于 CT 的回顾性队列分析。
Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography-Based Retrospective Cohort Analysis.
机构信息
Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Department of Orthopedic Surgery, Seoul Medical Center, Seoul, Korea.
出版信息
Arthroscopy. 2021 Aug;37(8):2554-2563.e1. doi: 10.1016/j.arthro.2021.03.008. Epub 2021 Mar 18.
PURPOSE
To determine whether the femoral tunnel position remains in an anatomical footprint after tunnel widening and shifting.
METHODS
Patients who underwent unilateral double-bundle anterior cruciate ligament reconstruction with hamstring autograft and performed computed tomography scan evaluation at the time of 5 days and 1 year postoperatively were included in this retrospective cohort study. Three-dimensional models of the femur and femoral tunnels were reconstructed from computed tomography scan data. The location of the tunnel center and tunnel margins in the anatomical coordinate system, and the mean shifting distance of tunnel center and margin were measured with image analysis software during the period. The change of tunnel center location in Bernard quadrant was confirmed if the tunnel center remained within the boundaries of anatomical position after tunnel widening.
RESULTS
A total of 56 patients satisfied the inclusion criteria. The mean shifting distance of AM and PL tunnel centers were 1.7 ± 0.9 mm and 1.6 ± 0.6 mm. The Tunnel margin of the anteromedial (AM) and posteromedial (PL) tunnels were shifted to 2.5 ± 1.3 mm and 2.6 ± 1.4 mm in the anterior direction, and 1.4 ± 0.9 mm and 1.0 ± 0.7 mm in the distal direction, respectively. Among the anatomical located tunnel, 97% (32/33) and 87.1% (27/31) of AM and PL tunnel centers remained in a range of anatomical footprint. The tunnel center was shifted from the anatomical position into a nonanatomical position in 3% (1/33) of the AM tunnel and 12.9% (4/31) of PL tunnel after tunnel widening. The tunnel location which shifted nonanatomically were relatively anterior and distal position.
CONCLUSIONS
Tunnel widening shifts the tunnel position to the anterior and distal direction, which could change the initial tunnel position. Nevertheless, the majority of tunnel positions remained in the anatomical position after tunnel widening and shifting.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
目的
确定在隧道扩宽和移位后股骨隧道位置是否仍保持在解剖学足迹内。
方法
本回顾性队列研究纳入了 56 例接受单侧双束前交叉韧带重建（自体腘绳肌腱）并在术后 5 天和 1 年行计算机断层扫描（CT）评估的患者。从 CT 扫描数据中重建股骨和股骨隧道的三维模型。使用图像分析软件，在解剖学坐标系中测量隧道中心和隧道边缘的位置以及隧道中心和边缘的平均移位距离。如果隧道中心在隧道扩宽后仍位于解剖位置的边界内，则确认隧道中心位置在 Bernard 象限中的变化。
结果
共 56 例患者符合纳入标准。AM 和 PL 隧道中心的平均移位距离分别为 1.7±0.9mm 和 1.6±0.6mm。前内侧（AM）和后内侧（PL）隧道的隧道边缘分别向前和向远端移位 2.5±1.3mm 和 2.6±1.4mm，1.4±0.9mm 和 1.0±0.7mm。在解剖定位的隧道中，97%（32/33）和 87.1%（27/31）的 AM 和 PL 隧道中心仍位于解剖学足迹范围内。AM 隧道中有 3%（1/33）和 PL 隧道中有 12.9%（4/31）的隧道中心在隧道扩宽后从解剖位置移位到非解剖位置。隧道位置向非解剖位置的移位是相对的前向和远侧位置。
结论
隧道扩宽会将隧道位置移向前方和远端，从而改变初始隧道位置。然而，在隧道扩宽和移位后，大多数隧道位置仍保持在解剖学位置。
证据等级
III 级，回顾性队列研究。
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