Remnant-preserving anterior cruciate ligament reconstruction using a three-dimensional fluoroscopic navigation system.
Remnant-preserving anterior cruciate ligament reconstruction using a three-dimensional fluoroscopic navigation system.
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DOI：
10.5792/ksrr.2014.26.3.168
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发表时间：
2014-09
影响因子：
3.1
通讯作者：
Nakagawa T
中科院分区：
文献类型：
--
作者：
Taketomi S;Inui H;Sanada T;Nakamura K;Yamagami R;Masuda H;Tanaka S;Nakagawa T
最近，为了实现血管重建、细胞增殖和高质量本体感觉的恢复，越来越多地进行了保留残余的前交叉韧带（ACL）重建。然而，在保留残余的ACL重建过程中，关节镜下较差的视觉效果使得准确的关节窝定位变得困难。本研究描述了一种外科技术，用于在技术要求苛刻的保留残余的ACL重建过程中，利用三维（3D）透视导航系统创建解剖性股骨窝。将参考框架附着在股骨上后，获得术中股骨远端图像，将其传输到导航系统并重建为3D图像。导航计算机帮助外科医生看到股骨切迹的整个外侧壁和外侧髁间嵴，即使当前交叉韧带破裂的残余阻碍了关节镜下骨表面的显示。放置导向器后，虚拟股骨隧道与重建的三维图像实时重叠；因此，只需要最小限度的软组织清创。我们使用该系统治疗了47例保留残余ACL重建患者。采用三维计算机断层成像，根据象限技术计算股骨窝孔中心。根据先前的尸体研究，股骨窝的位置被认为是一个解剖足迹。基于三维透视的导航可以帮助外科医生在保留残余的ACL重建过程中创建解剖性股骨窝。
Recently, remnant-preserving anterior cruciate ligament (ACL) reconstruction has been increasingly performed to achieve revascularization, cell proliferation, and recovery of high-quality proprioception. However, poor arthroscopic visualization makes accurate socket placement during remnant-preserving ACL reconstruction difficult. This study describes a surgical technique used to create an anatomical femoral socket with a three-dimensional (3D) fluoroscopy based navigation system during technically demanding remnant-preserving ACL reconstruction. After a reference frame was attached to the femur, an intraoperative image of the distal femur was obtained, transferred to the navigation system and reconstructed into a 3D image. A navigation computer helped the surgeon visualize the entire lateral wall of the femoral notch and lateral intercondylar ridge, even when the remnant of the ruptured ACL impeded arthroscopic visualization of the bone surface. When a guide was placed, the virtual femoral tunnel overlapped the reconstructed 3D image in real time; therefore, only minimal soft tissue debridement was required. We treated 47 patients with remnant-preserving ACL reconstruction using this system. The center of the femoral socket aperture was calculated according to the quadrant technique using 3D computed tomography imaging. The femoral socket locations were considered to be an anatomical footprint in accordance with previous cadaveric studies. The 3D fluoroscopy-based navigation can assist surgeons in creating anatomical femoral sockets during remnant-preserving ACL reconstruction.