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目的探讨膝关节镜手术在不同屈膝角度下前交叉韧带(ACL)单束解剖重建股骨隧道的解剖特点,以期为临床中ACL解剖重建提供解剖学数据。方法采用20例成人尸体双膝部标本,保留膝关节上下至少20 cm,排除关节明显退变、畸形及关节损伤。男性12例,女性8例,年龄在24~65岁,平均年龄37.3岁。标本固定于手术台上,允许膝关节90°~130°范围活动。分别屈膝90°、100°、110°、120°及130°经前内辅助入路(AMP)钻取股骨隧道,并用克氏针标记。镜下操作结束,切除膝关节标本周围软组织,暴露隧道的外口。用游标卡尺测量裸露在股骨隧道外的克氏针长度,间接计算股骨隧道长度。再摄膝关节标本正位X线片,摄正位片时股骨侧以内外股骨髁皮质突出点为旋转标记,测量克氏针与髁间窝外侧壁在水平面的夹角,即横向钻角。结果本研究发现在同一尸体标本上,不同的膝关节角度下可以得到不同的股骨隧道长度和横向钻角。不同膝关节下测量的股骨隧道长度存在统计学差异(F=228.15,P=0.000),不同膝关节下测量的横向钻角存在统计学差异(F=930.71,P=0.000)。Pearson相关性分析股骨隧道长度和横向钻角二者间存在相关性(r=-0.908),股骨隧道长度与横向钻角存在负相关。结论国家级下经AMP入路解剖重建ACL时不同的膝关节角度影响股骨隧道的方向和长度。
Objective To investigate the anatomical characteristics of single bundle anterior cruciate ligament (ACL) anatomical reconstruction of the femoral tunnel with different knee flexion under knee arthroscopy in order to provide anatomical data for anatomic reconstruction of ACL in clinical practice. Methods Twenty adult cadaveric knees were used to keep the knee joint at least 20 cm above and below the knee joint, and the obvious degeneration, deformity and joint injury were excluded. 12 males and 8 females, aged from 24 to 65 years, with an average age of 37.3 years. The specimen is fixed on the operating table, allowing the range of motion of the knee joint 90 ° ~ 130 °. The femoral tunnels were drilled with knee flexion at an angle of 90 °, 100 °, 110 °, 120 ° and 130 °, respectively, and labeled with Kirschner wire. Microscope operation ended, excision of soft tissue around the knee specimens, exposing the outer mouth of the tunnel. The length of Kirschner wires exposed outside the femoral tunnel was measured with a vernier caliper and the length of the femoral tunnel was calculated indirectly. Then take the knee anteroposterior X-ray film, take the anteroposterior film when the femoral side of the femoral condyle cortex to highlight the point of rotation to measure the Kirschner and intercondylar fossa lateral wall in the horizontal angle, that is, horizontal drill angle. Results The present study found that different tunnel angles and transverse tunnel angles can be obtained at different knee angles on the same cadaver specimen. There was a significant difference in the length of femur tunnel measured under different knee joints (F = 228.15, P = 0.000). There was a statistically significant difference (F = 930.71, P = 0.000) between transverse knee angles measured under different knee joints. Pearson correlation analysis There was a correlation between the length of the femoral tunnel and the horizontal drilling angle (r = -0.908). There was a negative correlation between the length of the femoral tunnel and the horizontal drilling angle. Conclusions Different knee angles affect the direction and length of the femoral tunnel when the ACL is dissected and reconstructed by AMP at national level.