摘要
背景:目前,前交叉韧带重建过程中定位胫骨隧道标准为隧道冠状位和关节面水平呈65°-70°,角度过大容易引起撞击,而角度过小则会损伤胫骨内侧平台关节面。目的:分析计算机联合关节镜利用带血管蒂髌韧带修复交叉韧带方法及效果。方法:选取40例膝关节前交叉韧带损伤患者资料,随机分为2组,每组20例。两组患者均采用相同定位胫骨隧道标准,传统手术组术中凭借医师经验进行重建,计算机导航辅助关节镜组术中采用计算机联合关节镜利用带血管蒂髌韧带修复,修复后患者行CT连续断层扫描并测量前交叉韧带胫骨隧道,比较两组重建效果。结果与结论:(1)计算机导航辅助关节镜组治疗后股骨隧道位置、胫骨隧道位置,显著高于传统手术组(P<0.05);(2)计算机导航辅助关节镜组治疗后3,6个月以及治疗后1年Lysholm评分显著高于传统手术组(P<0.05);(3)计算机导航辅助关节镜组治疗后透射次数显著少于传统手术组(P<0.05);(4)CT矢状位断层及三维CT显示计算机导航辅助关节镜组治疗后隧道后壁与胫骨近端后方皮质均紧密贴近,贴合距离在2 mm内;传统手术组患者术后隧道近端1/3后壁出口部位出现轻度破裂。(5)结果提示,计算机导航辅助关节镜下重建前交叉韧带效果理想,使得术中股骨隧道定位更加准确,通过导航虚拟探针能准确预测隧道长度、角度,避免了凭借医师肉眼进行主观定位,实用性较强,具有较高的临床应用价值。
BACKGROUND： The standard angle between the coronal level of tibial tunnel and the joint surface is 65°-70°. The larger angle is easy to cause impacts, and inversely, the medial joint surface of the tibia plateau will be worn.OBJECTIVE： To investigate the application and effects of patellar ligament with vascular pedicle for anterior cruciate ligament reconstruction under computer assisted navigation system combined with arthroscopy. METHODS： Forty patients with anterior cruciate ligament injury were selected, and randomly allotted into two groups（n=20 per group）. Patients in traditional surgery group underwent reconstruction by the operator＇s experiences, and patients in combination surgery group received the patellar ligament with vascular pedicle for anterior cruciate ligament reconstruction under computer assisted navigation system combinied with arthroscopy, both based on the same location standard. Subsequently, patients underwent CT continuous CT scans, and the tibial tunnel of anterior cruciate ligament was measured to compare the reconstruction effects. RESULTS AND CONCLUSION： The tibial tunnel and femoral tunnel positions in the combination surgery group were significantly higher than those in the traditional surgery group（P〈0.05）. The Lysholm scores in the combination surgery group were significantly higher than those in the traditional surgery group at 3, 6 and 12 months after surgery（P〈0.05）. Compared with the traditional surgery group, the number transmission times was significantly decreased in the combination surgery group（P〈0.05）. Furthermore, sagittal CT and three-dimensional CT results showed that, in the combination surgery group, the posterior wall of the tibial tunnel closely adhered to the rear cortical bone of the proximal tibia with a distance of 2 mm; a mild rupture appeared at the posterior wall excit of the 1/3 proximal tunnel in traditional surgery group. These results suggest that anterior cruciate ligament reconstuction under computer assisted navigation system combined with arthroscopy achieves satisfactory effects on location of the femoral tunnel. The use of navigation virtual probe avoids the subjective location by surgeons; therefore, it is feasible for clinical treatment.
出处
《中国组织工程研究》
CAS
北大核心
2016年第37期5538-5544,共7页
Chinese Journal of Tissue Engineering Research
基金
国家自然科学基金(81401833)~~
