Optimal orientation of the bone tunnels in the anterior cruciate ligament reconstruction

前十字韧带重建中骨隧道的最佳方向

• 批准号: 05671217
• 负责人: KUROSAKA Masahiro
• 金额: $ 1.34万
• 依托单位: Kobe University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1993
• 资助国家: 日本
• 起止时间: 1993 至 1994
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-05671217/
• 关键词: Knee joint; Biomechanics; Ligament; Anterior Cruciate Ligament; 前十字靭帯; 靭帯; 主体力学; 十字靭帯; 膝蓋腱

Although large internal pressure are reported to occur in ligament grafts at bone tunnels, little is known about the optimal bone tunnels in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to determine the optimal orientation of the bone tunnels in the ACL reconstruction. Optimal orientation is defined to be such that the bending and strain imposed on the graft throughout the range of motion is minimal. First, in the numerical analysis, optimal orientataion of the drill holes was investigated by computer reconstituted three dimensional knee model. Secondly, in the experiment using fresh cadeveric knees, the orientation of drill holes and bending angle of in the grafts were measured by analysing the two dimensional radiografs taken with the specially desined apparatus. The optomal orientation of the drill hole of the femur tilted 20_O laterally in coronal plane and 23_O anteriorly in sagital plane. In the tibia, drill hole should be directed 24_O medially and 50_O anteriorly from the isometric point. Numerically analyzed bening angle corresponded well to the experimental study and the maximal bending angle were 58_O for the femur and 18_O for the tibia respectively. The deformity of the graft in the femoral side is larger than that in the tibial side. Since there is restriction as to the possible orientation of the bone tunnels in femur with current reconstructive procedure, a different drilling system such as inside-out drilling appears to be advantageous to prevent early failure of the graft after ACL reconstruction.

尽管骨隧道处的韧带移植物会产生较大的内压，但对于重建前十字韧带(ACL)的最佳骨隧道却知之甚少。本研究的目的是确定重建前交叉韧带时骨隧道的最佳方向。最优取向的定义是，在整个运动范围内，施加在移植物上的弯曲和应变最小。首先，在数值分析中，利用计算机重建的三维膝关节模型对钻孔的最佳方位进行了研究。其次，在新鲜膝关节的实验中，通过对专用仪器拍摄的二维X线片进行分析，测量了植骨中钻孔的方位和弯曲角度。股骨钻孔在冠状面上向外倾斜20°，在矢状面上向前倾斜23°。在胫骨，钻孔应从等长点向内侧24度，向前50度。数值分析结果与实验结果吻合较好，股骨最大弯曲角度为58°，胫骨最大弯曲角度为18°。股骨侧移植物畸形大于胫侧移植物。由于目前的重建方法对股骨内骨隧道的可能方向有限制，不同的钻孔系统，如内向外钻孔，似乎有利于防止前交叉韧带重建后移植物的早期失败。

项目成果

山口基・他: "膝前十字靭帯再建術におけるドリル孔作製方向について" 日本整形外科学会雑誌. (発表予定).

Hajime Yamaguchi 等人：“前十字韧带重建中的钻孔准备方向”，日本骨科学会杂志（待出版）。

Kurosaka, M et al: "Optimal orientation of bone tunnels in the posterior cruciate ligament reconstruction" Transactions of the Orthopaedic Research Society. 18. 304 (1993)

Kurosaka, M 等人：“后十字韧带重建中骨隧道的最佳方向”骨科研究学会汇刊。

Yoshiya, S et al: "Optimal orientation of the bone tunnels in the anterior cruciate ligament reconstruction" Transactions of the Orthopaedic Research Society. 16. 602 (1991)

Yoshiya, S 等人：“前十字韧带重建中骨隧道的最佳方向”《骨科研究学会汇刊》。