后交叉韧带3D模型技术获取低位胫骨隧道解剖参数研究

陈思捷, 郭来威, 王遵林, 谭念, 张康瑞, 韵向东, 夏亚一, 滕元君

中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (5) : 505-510.

PDF(1895 KB)
PDF(1895 KB)
中国临床解剖学杂志 ›› 2023, Vol. 41 ›› Issue (5) : 505-510. DOI: 10.13418/j.issn.1001-165x.2023.5.01
断层影像解剖

后交叉韧带3D模型技术获取低位胫骨隧道解剖参数研究

  • 陈思捷1,2,    郭来威1,    王遵林1,2,    谭念1,2,    张康瑞1,2,    韵向东1,    夏亚一1,2,    滕元君1,2*
作者信息 +

Study on anatomical parameters of low tibial tunnel in posterior cruciate ligament reconstruction based on 3D surgical simulation technology

  • Chen Sijie1.2, Guo Laiwei1, Wang Zunlin1.2, Tan Nian1.2, Zhang Kangrui1.2, Yun Xiangdong1, Xia Yayi1.2, Teng Yuanjun1.2*
Author information +
文章历史 +

摘要

目的    基于后交叉韧带(posterior cruciate ligament,PCL)3D模型技术建立低位胫骨隧道并测量其解剖参数。  方法    选取101例健康膝关节CT影像资料,利用Mimics21.0(Materialise,比利时)软件建立PCL 3D虚拟手术模型并建立前内侧与前外侧入路的低位胫骨隧道,测量胫骨隧道长度(length of the PCL tibial tunnel,LTT),胫骨隧道与胫骨平台3D夹角(3D included angle between tibial medial axis extension line and tibial plateau,3D ATPT)以及隧道入口点到胫骨平台距离(perpendicular distance of the tunnel’s entry point to the tibial plateau,PTT)。利用SPSS 25.0进行统计学分析。  结果    前内侧与前外侧胫骨隧道参数测量,LTT分别为(45.56±4.27)mm、(43.93±4.10)mm,差异有统计学意义(P<0.05);3D ATPT分别为(48.17±6.12)°、(54.49±5.81)°,差异有统计学意义(P<0.05);PTT分别为(61.86±6.80)mm、(63.51±6.32)mm,差异有统计学意义(P<0.05)。  结论    测量PCL的3D模型低位胫骨隧道相关参数,可为临床PCL重建手术提供理论参考。

Abstract

Objective     To establish the low tibial tunnel based on the posterior cruciate ligament (PCL) 3D virtual technology to measure its anatomical parameters.    Methods    CT image data of 101 patients with healthy knee joints were selected, and PCL 3D virtual surgery model was established by using mimics21.0 (Materialise, Belgium) software. Low tibial tunnels of anteromedial and anterolateral approaches were established respectively. The anatomical parameters included the length of the posterior cruciate ligament tibial tunnel (LTT), the 3D included angle between tibial medial axis extension line and tibial plateau (3D ATPT) and perpendicular distance of the tunnel’s entry point to the tibial plateau (PTT). SPSS 25.0 was used for statistical analysis.    Results   The average length of PCL tibial tunnel was greater in the anteromedial group than the anterolateral group was (45.56±4.27) mm versus (43.93±4.10) mm, P<0.05. The average 3D angle between tunnel and tibial plateau was greater in the anterolateral than the anteromedial (54.49±5.81)° versus (48.17±6.12) °, P<0.05. The PTT in the anteromedial group and the anterolateral group were (61.86±6.80) mm and (63.51±6.32) mm, respectively (P<0.05). All the above parameters had statistical differences.   Conclusions    The parameters related to the low tibial tunnel measured in this study can provide theoretical reference for PCL reconstruction surgery in clinical practice.

关键词

后交叉韧带;  /   / 3D手术模拟;  /   / 膝关节;  /   / 胫骨骨道

Key words

Posterior cruciate ligament;  /   / 3D surgical simulation;  /   / Knee joint;  /   /  Tibial tunnel

引用本文

导出引用
陈思捷, 郭来威, 王遵林, 谭念, 张康瑞, 韵向东, 夏亚一, 滕元君. 后交叉韧带3D模型技术获取低位胫骨隧道解剖参数研究[J]. 中国临床解剖学杂志. 2023, 41(5): 505-510 https://doi.org/10.13418/j.issn.1001-165x.2023.5.01
Chen Sijie, Guo Laiwei, Wang Zunlin, Tan Nian, Zhang Kangrui, Yun Xiangdong, Xia Yayi, Teng Yuanjun. Study on anatomical parameters of low tibial tunnel in posterior cruciate ligament reconstruction based on 3D surgical simulation technology[J]. Chinese Journal of Clinical Anatomy. 2023, 41(5): 505-510 https://doi.org/10.13418/j.issn.1001-165x.2023.5.01
中图分类号: R686.5    

参考文献

[1]  Papannagari R, Defrate LE, Nha KW, et al. Function of posterior cruciate ligament bundles during in vivo knee flexion[J]. Am J Sports Med, 2007, 35(9): 1507-1512. DOI: 10.1177/0363546507300061.
[2]  胡岩君, 余斌, 苏秀云, 等. 基于MRI、CT影像下膝关节及交叉韧带重建可视化的初步应用研究[J]. 中华创伤骨科杂志, 2007, (5): 469-472. DOI: 10.3760/cma.j.issn.1671-7600.2007.05.018.
[3] Ahn JH, Bae JH, Lee YS, et al. An anatomical and biomechanical comparison of anteromedial and anterolateral approaches for tibial tunnel of posterior cruciate ligament reconstruction: evaluation of the widening effect of the anterolateral approach[J]. Am J Sports Med, 2009, 37(9): 1777-1783. DOI: 10.1177/0363546509332508.
[4] Fanelli GC, Edson CJ. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results[J]. J Knee Surg, 2012, 25(4): 307-316. DOI: 10.1055/s-0032-1326997.
[5]  Huang TW, Wang CJ, Weng LH, et al. Reducing the “killer turn” in posterior cruciate ligament reconstruction[J]. Arthroscopy, 2003, 19(7): 712-716. DOI: 10.1016/s0749-8063(03)00394-3.
[6]  Lee YS, Jung YB. Posterior cruciate ligament: focus on conflicting issues[J]. Clin Orthop Surg, 2013, 5(4): 256-262. DOI: 10.4055/cios.2013.5.4.256.
[7]  Ansari AS, Dennis BB, Horner NS, et al. Influence of graft source on postoperative activity and joint laxity in posterior cruciate ligament reconstruction: a systematic review[J]. Arthroscopy, 2019, 35(1): 262-274.e6. DOI: 10.1016/j.arthro.2018.07.027.
[8]  Teng Y, Da L, Jia G, et al. What is the maximum tibial tunnel angle for transtibial PCL reconstruction? A comparison based on virtual radiographs, CT images, and 3D knee models[J]. Clin Orthop Relat Res, 2022, 480(5): 918-928. DOI: 10.1097/CORR.0000000000002111.
[9]  陈航, 顾海峰. 由后向前建立胫骨隧道的全内后交叉韧带重建治疗后交叉韧带损伤的近期疗效[J]. 中华创伤骨科杂志, 2019, (1): 76-80. DOI: 10.3760/cma.j.issn.1671-7600.2019.01.014.
[10]Wang Z, Xiong Y, Li Q, et al. Evaluation of tibial tunnel placement in single case posterior cruciate ligament reconstruction: reducing the graft peak stress may increase posterior tibial translation[J]. BMC Musculoskelet Disord, 2019, 20(1): 521-528. DOI: 10.1186/s12891-019-2862-z.
[11]Weimann A, Wolfert A, Zantop T, et al. Reducing the "killer turn" in posterior cruciate ligament reconstruction by fixation level and smoothing the tibial aperture[J]. Arthroscopy, 2007, 23(10): 1104-1111. DOI: 10.1016/j.arthro.2007.04.014.
[12]夏亚一, 滕元君, 呼杰, 等. 后交叉韧带损伤重建术中“杀伤角”效应的研究进展[J]. 中华创伤杂志, 2022, 38(1): 86-91. DOI: 10.3760/cma.j.cn501098-20210901-00473.
[13] Shin YS, Han SB, Hwang YK, et al. Tibial tunnel aperture location during single-bundle posterior cruciate ligament reconstruction: comparison of tibial guide positions[J]. Arthroscopy, 2015, 31(5): 874-881. DOI: 10.1016/j.arthro.2014.12.004.
[14] Zhang X, Teng Y, Yang X, et al. Evaluation of the theoretical optimal angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography[J]. BMC Musculoskelet Disord, 2018, 19(1): 436-441. DOI: 10.1186/s12891-018-2348-4.
[15] Fanelli GC, Beck JD, Edson CJ. Double bundle posterior cruciate ligament reconstruction: surgical technique and results[J]. Sports Med Arthrosc Rev, 2010, 18(4): 242-248. DOI: 10.1097/JSA.0b013e3181f2faa1.
[16]Fanelli GC, Giannotti BF, Edson CJ. The posterior cruciate ligament arthroscopic evaluation and treatment[J]. Arthroscopy, 1994, 10(6): 673-688. DOI: 10.1016/s0749-8063(05)80067-2.
[17]Okoroafor UC, Saint-Preux F, Gill SW, et al. Nonanatomic tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction leads to greater posterior tibial translation in a biomechanical model[J]. Arthroscopy, 2016,32(7): 1354-1358. DOI: 10.1016/j.arthro. 2016. 01.019.
[18]Fanelli GC. Arthroscopic transtibial tunnel posterior cruciate ligament reconstruction[J]. Oper Tech Sports Med, 2015, 23(4): 289-297. DOI: 10.1053/j.otsm.2015.06.005.
[19]Wang Z, Xiong Y, Chen G, et al. Modified tibial tunnel placement for single-bundle posterior cruciate ligament reconstruction reduces the "Killer Turn" in a biomechanical model[J]. Medicine (Baltimore), 2019, 98(52): e18439-e18435. DOI: 10.1097/MD.0000000000018439.
[20]Lin Y, Huang Z, Zhang K, et al. Lower tibial tunnel placement in isolated posterior cruciate ligament reconstruction: clinical outcomes and quantitative radiological analysis of the killer turn[J]. Orthop J Sports Med, 2020, 8(8): 2325967120923950-2325967120923960. DOI: 10.1177/2325967120923950.
[21]Yoon KH, Kim JS, Park JY, et al. Comparable clinical and radiologic outcomes between an anatomic tunnel and a low tibial tunnel in remnant-preserving posterior cruciate ligament reconstruction[J]. Orthop J Sports Med, 2021, 9(2): 2325967120985153-2325967120 985160. DOI: 10.1177/2325967120985153.
[22]Jarvis DL, Waterman BR. Editorial commentary: stump sparing or footprint exposing? Management of the tibial remnant during posterior cruciate ligament reconstruction[J]. Arthroscopy, 2019, 35(9): 2669-2670. DOI: 10.1016/j.arthro.2019.05.035.
[23]陆文杰, 成立, 施绒舟, 等. 胫骨骨道定位对后交叉韧带重建“杀伤角”的影响[J]. 中华创伤杂志, 2012, (8): 712-717. DOI: 10.3760/cma.j.issn.1001-8050.2012.08.013.
[24]Fanelli GC. Transtibial posterior cruciate ligament reconstruction[J]. J Knee Surg, 2021, 34(5): 486-492. DOI: 10.1055/s-0040-1722696.
[25]Teng Y, Zhang X, Ma C, et al. Evaluation of the permissible maximum angle of the tibial tunnel in transtibial anatomic posterior cruciate ligament reconstruction by computed tomography[J]. Arch Orthop Trauma Surg, 2019, 139(4): 547-552. DOI: 10.1007/s00402-018-3092-9.

基金

兰州大学医学教育创新发展项目(lzuxcx-2022-173/lzuyxcx-2022-97);国家级大学生创新创业训练计划(202310730192);兰州大学第二医院萃英科技创新计划项目(CY2021-QN-A14);甘肃省高等学校创新基金项目(2022B-044)

PDF(1895 KB)

Accesses

Citation

Detail

段落导航
相关文章

/