摘要
目的:探究传统前交叉韧带(anterior cruciate ligament, ACL)重建手术中钻制圆形胫骨骨道是否会对外侧半月板前角(anterior horn of lateral meniscus, AHLM)附着部造成医源性损伤以及损伤程度。方法:选取新鲜冰冻人体膝关节标本10例,关节镜下行单束解剖ACL重建术。标本从中段切断ACL,刨削系统仔细刨削ACL纤维,充分暴露ACL胫骨止点与外侧半月板前角。术中应用关节镜量尺测量AHLM附着部的原始长度及宽度,随后定位器定位钻取胫骨骨道,骨道直径为8 mm,钻取骨道后再次应用关节镜下比例尺测量AHLM的损伤长度及宽度。术后剖开膝关节标本,大体下确认AHLM附着部的损伤情况。结果:AHLM附着部的原始长度为8.71±1.39 mm,原始宽度为11.75±0.85 mm。在钻取胫骨骨道后,所有标本(10/10)的AHLM附着部均受到了损伤,其平均损伤长度为4.47±1.08 mm,平均损伤宽度为6.29±1.17 mm,分别占其原始长、宽的51.6%、53.5%。结论:在行ACL单束重建手术时,应用8 mm的圆形骨钻制胫骨骨道会不可避免地造成外侧半月板前角附着部损伤,应当引起临床医生的注意。未来的研究应进一步明确该损伤的临床意义及改进方法。
Objective To explore whether the conventional round tibial tunnel would cause the iatrogenic injury to the insertion site of the anterior horn of lateral meniscus(AHLM) during the conventional anterior cruciate ligament(ACL) reconstruction and evaluate the severity of such injury. Methods Ten fresh-frozen human cadaveric knees were tested under arthroscopy. The ACL was cut in the midsubstance and then the ACL fibers were carefully shaved to its insertion site, completely exposing the relationship between insertion site of ACL and AHLM. Using an arthroscopic ruler to measure the length and width of the native AHLM insertion site. Then an aiming guide was utilized and the tibial tunnel was reamed with a 8-mm diameter reamer. After reaming, the arthroscopic ruler was used again to measure the length and width of the injury site. The knees were disarticulated, exposing the tibial tunnel and AHLM on the tibial plateaus to confirm the injury. Results The average length and width of the native AHLM insertion site was 8.71 ± 1.39 mm and 11.75 ± 0.85 mm, respectively. After tibial tunnel reaming, all specimens were found to have the iatrogenic injury in the AHLM insertion site.The mean length and width of the injury site was 4.47 ± 1.08 mm and 6.29 ± 1.17 mm, respectively,accounting for 51.6% and 53.9% of the native AHLM insertion site. Conclusions Utilizing an 8-mm diameter reamer during single-bundle ACL reconstruction can cause unavoidable iatrogenic injury to the AHLM, which has been ignored in the current clinical practice.
作者
邵嘉艺
张家豪
刘平
敖英芳
Shao Jiayi;Zhang Jiahao;Liu Ping;AoYingfang(Institute of Sports Medicine,Peking University Third Hospital,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China)
出处
《中国运动医学杂志》
CAS
CSCD
北大核心
2020年第6期470-475,共6页
Chinese Journal of Sports Medicine
基金
北京大学第三医院院临床重点项目(BYSY2018005)。
关键词
前交叉韧带胫骨止点
外侧半月板前角
医源性损伤
ACL tibial insertion site
anterior horn of lateral meniscus
iatrogenic injury
