He Renjie, Ning Ziwen, Gu Ziming, Shi Zhengliang, Xiang Yaoyu, Wang Guoliang, Li Yanlin, He Chuan
Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2023 Jul 15;37(7):833-838. doi: 10.7507/1002-1892.202303012.
To investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral locator based on the apex of deep cartilage (ADC) combined with patient imaging data.
Between January 2021 and January 2022, a total of 40 patients with primary ACL rupture were selected and randomly divided into study group (ACL reconstruction assisted by personalized femoral locator based on ADC) and control group (ACL reconstruction assisted by intraoperative fluoroscopy and traditional femoral locator), with 20 cases in each group. There was no significant difference in gender, age, body mass index, affected side, cause of injury, and preoperative International Knee Documentation Committee (IKDC) score, Lyshlom score, and Tegner score between the two groups ( >0.05). IKDC score, Lyshlom score, and Tegner score were used to evaluate the functional recovery of the affected knee before operation and at 3, 6, and 12 months after operation. CT scan and three-dimensional reconstruction were performed before and after operation to measure the horizontal distance from ADC to the anterior cartilage margin (L) and the horizontal distance from ADC to the center of the femoral canal (I), and the anteroposterior position of the bone canal (R) was calculated by I/L; the distance from the center to the distal cartilage margin (D) was measured on the two-dimensional cross section; the R value and D value were compared between the two groups.
The operation time of the study group was significantly less than that of the control group [ =-6.90 (-8.78, -5.03), <0.001]. The incisions of the two groups healed by first intention, and no complication such as intra-articular infection, nerve injury, and deep vein thrombosis of lower limbs occurred. There was no significant difference in the R value and D value between the preoperative simulated positioning and the actual intraoperative positioning in the study group [ =0.52 (-2.85, 3.88), =0.758; =0.36 (-0.39, 1.11), =0.351]. There was no significant difference in the actual intraoperative positioning R value and D value between the study group and the control group [ =1.01 (-2.57, 4.58), =0.573; =0.24 (-0.34, 0.82), =0.411]. The patients in both groups were followed up 12-13 months (mean, 12.4 months). The IKDC score, Lysholm score, and Tegner score of the two groups increased gradually with time, and there were significant differences between pre- and post-operation ( <0.05). There was no significant difference in the scores between the two groups at each time point after operation ( >0.05).
The personalized femoral locator based on ADC can accurately assist the femoral tunnel positioning in ACL reconstruction, which can shorten the operation time when compared with traditional surgical methods, and achieve satisfactory early effectiveness.
探讨基于深层软骨顶点（ADC）结合患者影像数据的个性化股骨定位器辅助前交叉韧带（ACL）重建的有效性。
选取2021年1月至2022年1月期间40例原发性ACL断裂患者，随机分为研究组（基于ADC的个性化股骨定位器辅助ACL重建）和对照组（术中透视及传统股骨定位器辅助ACL重建），每组20例。两组患者在性别、年龄、体重指数、患侧、损伤原因以及术前国际膝关节文献委员会（IKDC）评分、Lyshlom评分和Tegner评分方面比较，差异均无统计学意义（>0.05）。采用IKDC评分、Lyshlom评分和Tegner评分评估患侧膝关节术前及术后3、6、12个月的功能恢复情况。术前及术后行CT扫描及三维重建，测量ADC至股骨前软骨边缘的水平距离（L）以及ADC至股骨髓腔中心的水平距离（I），并通过I/L计算骨隧道的前后位置（R）；在二维横断面上测量中心至股骨远端软骨边缘的距离（D）；比较两组的R值和D值。
研究组手术时间显著短于对照组[=-6.90（-8.78，-5.03），<0.001]。两组切口均一期愈合，未发生关节内感染、神经损伤及下肢深静脉血栓等并发症。研究组术前模拟定位与术中实际定位的R值和D值比较，差异均无统计学意义[=0.52（-2.85，3.88），=0.758；=0.36（-0.39，1.11），=0.351]。研究组与对照组术中实际定位的R值和D值比较，差异均无统计学意义[=1.01（-2.57，4.58），=0.573；=0.24（-0.34，0.82），=0.411]。两组患者均随访12~13个月（平均12.4个月）。两组IKDC评分、Lysholm评分和Tegner评分均随时间逐渐升高，术前与术后比较差异有统计学意义（<0.05）。术后各时间点两组评分比较，差异均无统计学意义（>0.05）。
基于ADC的个性化股骨定位器能准确辅助ACL重建中的股骨隧道定位，与传统手术方法相比可缩短手术时间，并取得满意的早期效果。
