前交叉韧带解剖重建股骨隧道与外侧副韧带解剖重建股骨隧道的关系

目的探讨前交叉韧带(ACL)单束解剖重建股骨隧道与外侧副韧带(LCL)重建股骨隧道的关系,以期为临床中ACL解剖重建提供解剖学数据,便于临床实际操作中避免2个股骨隧道相互干扰,为ACL和LCL一期解剖重建提供依据。方法采用30例成人尸体膝部标本,保留膝关节上下至少20cm,排除关节明显退变、畸形及关节损伤。男性16例,女性14例,年龄在23~66岁,平均年龄38.7岁。屈膝120°经前内辅助入路(AMP)钻取股骨隧道。在股骨外髁外侧面寻找后外侧角(PLC)结构,钝性分离LCL,并钻取LCL隧道。标本进行CT扫描,在CT片上观察隧道碰撞数,并计算两个隧道的最短距离。结果在LCL股骨隧道深度为25mm时,其与ACL股骨隧道最短距离为(3.9±2.4)mm;在LCL股骨隧道深度为30mm时,其与ACL股骨隧道最短距离为(2.7±1.9)mm。在ACL股骨隧道深度为25mm时,其与LCL股骨隧道的最短距离为(4.4±2.6)mm;在ACL股骨隧道深度为30mm时,其与LCL股骨隧道的最短距离为(3.2±2.1)mm。在30例标本中,共发现6例隧道碰撞,碰撞的几率高达20%。结论我们发现两者隧道发生碰撞的几率高,临床一期解剖重建时,术前应做个体化准备,规划好LCL重建所需股骨隧道的长度和隧道直径,从而规避与ACL股骨隧道的碰撞。

Relationship between anterior cruciate ligament anatomical reconstruction femoral tunnel and lateral collateral ligament femoral tunnel

Objective To investigate the relationship between the anterior cruciate ligament (ACL) single-bundle anatomical reconstruction femoral tunnel and the lateral collateral ligament(LCL) reconstruction femoral tunnel, in order to provide the anatomical data for ACL and LCL one-stage reconstruction and to avoid mutual interference between the two femoral tunnels. Methods Thirty adult cadaveric knees without degeneration, deformity and joint damage were utilized. The cutting ends of each specimen were at least 20cm above and below the knee. The cadavers were 16 males and 14 females, aged from 23 to 66 years, 38.7 years for average. The femoral tunnel was drilled through an accessory medial portal (AMP) at 120°of knee flexion. The posteriolateral corner ligament (PLC) in the outer surface of lateral femoral condyle was visualized and the LCL was isolated and the LCL tunnel was drilled. All the specimens were underwent CT scan to observe the tunnel collisions on CT slices, and calculate the shortest distance between two tunnels. Results The shortest distance between the LCL reconstruction femoral tunnel and the ACL reconstruction femoral tunnel was (3.90±2.40)mm when the depth of LCL tunnel was 25mm. The shortest distance between the LCL tunnel and the ACL tunnel was (2.70±1.90)mm when the LCL tunnel depth was 30mm. The shortest distance between the LCL tunnel and the ACL tunnel was (4.4±2.60)mm when the ACL tunnel depth was 25mm. The shortest distance between the LCL tunnel and the ACL tunnel was (3.2±2.10)mm when the ACL tunnel depth was 30mm. Among 30 specimens, 6 cases were found tunnel collisions, the collision probability as high as 20%. Conclusion The risk of tunnel collisions between the reconstruction femoral LCL and ACL tunnels is high. Thus, when the one-stage of clinical anatomical reconstruction, preoperative preparation should be individualized, and the length and diameter of the femoral tunnel for reconstruction LCL should be planned to avoid collision with the ACL femoral tunnel.