基于Mimics的三维CT重建评估不同技术重建前交叉韧带的骨隧道位置

目的：比较改良经胫骨隧道（modified transtibial，MTT）技术与经前内侧入路（anteromedial portal，AM）技术进行单束前交叉韧带重建的骨隧道定位情况。方法：回顾性分析2017年1月至2020年9月进行单束前交叉韧带重建的78例患者的临床资料。其中39例采用MTT技术重建（MTT组），男25例，女14例，年龄（37.0±2.3）岁；39例采用AM技术重建（AM组），男27例，女12例，年龄（37.5±2.2）岁。术后1周内行膝关节CT平扫，运用Mimics软件测量并比较两组患者股骨隧道中心点的相对位置百分比（Fx、Fy），胫骨冠状面骨隧道中心点的相对位置百分比（Tx1），胫骨矢状面骨隧道中心点的相对位置百分比（Ty1）及胫骨轴面骨隧道中心点的相对位置百分比（Tx2、Ty2）。结果：78例患者均成功重建骨隧道，MTT组患者的Fx、Fy分别为（25.2±2.1）%、（34.9±3.0）%；Tx1、Ty1分别为（45.5±3.3）%、（44.7±3.0）%；Tx2、Ty2分别为（47.0±3.0）%、（39.9±4.2）%。AM组患者的Fx、Fy分别为（26.0±2.0）%、（36.1±3.9）%；Tx1、Ty1分别为（46.5±3.1）%、（45.6±3.1）%；Tx2、Ty2分别为（47.4±2.5）%、（39.6±3.9）%。两组骨隧道中心点的相对位置百分比比较差异均无统计学意义（P>0.05），两组患者均获得解剖重建。结论：采用改良经胫骨隧道技术和经前内侧入路技术重建前交叉韧带，均可实现解剖重建，骨隧道位置无明显差异。

Bone tunnel positions in anterior cruciate ligament reconstruction evaluated by three-dimensional CT reconstruction based on Mimics software: modified transtibial versus anteromedial portal technique

Objective: To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial(MTT) technique and anteromedial(AM) portal technique.Methods: Between January 2017 and September 2020,78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases(group AM). There were 25 males and 14 females in group MTT,with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM,with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx,Fy),tibial tunnels positioning in the frontal plane(Tx1),tibial tunnels positioning in the sagittal plane (Ty1),and tibial tunnels positioning in the axial plane (Tx2,Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.Results: Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7±3.0)% respectively,while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM,the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6±3.1)% respectively,while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups(P>0.05). Patients in both two groups obtained anatomic anterior cruciate ligament reconstruction.Conclusion: Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels,without significant differences in the positioning of the bone tunnels.