中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (17): 3139-3142.doi: 10.3969/j.issn.1673-8225.2011.17.024

• 数字化骨科 digital orthopedics • 上一篇    下一篇

计算机导航技术在后交叉韧带重建胫骨隧道定位中的应用

熊健斌，赵劲民，沙  轲，程建文，韦庆军   

  1. 广西医科大学第五附属医院(柳州人民医院)，广西壮族自治区柳州市  545000
  • 收稿日期:2010-11-21 修回日期:2011-02-07 出版日期:2011-04-23 发布日期:2011-04-23
  • 通讯作者: 韦庆军，副主任医师，硕士生导师，主要从事创伤关节的研究。 weiqingjungxnn@163.com
  • 作者简介:熊健斌★，男，1977年生，广西壮族自治区柳州市人，汉族，2000年广西医科大学毕业，硕士，主要从事创伤、关节疾病研究。 xiongjianbin@163.com
  • 基金资助:

    广西省卫生厅2008年医学科学研究重点课题计划(桂卫重200835)。

Application of computer navigation system in tibial tunnel positioning during reconstruction of posterior cruciate ligament

Xiong Jian-bin, Zhao Jin-min, Sha Ke, Cheng Jian-wen, Wei Qing-jun   

  1. Fifth Affiliated Hospital of Guangxi Medical University (People’s Hospital of Liuzhou), Liuzhou  545000, Guangxi Zhuang Autonomous Region, China
  • Received:2010-11-21 Revised:2011-02-07 Online:2011-04-23 Published:2011-04-23
  • Contact: Wei Qing-jun, Associate chief physician, Master’s supervisor, Fifth Affiliated Hospital of Guangxi Medical University (People’s Hospital of Liuzhou), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China weiqingjungxnn@163.com
  • About author:Xiong Jian-bin★, Master, Fifth Affiliated Hospital of Guangxi Medical University (People’s Hospital of Liuzhou), Liuzhou 545000, Guangxi Zhuang Autonomous Region, China xiongjianbin@163.com
  • Supported by:

    Medical Science and Technology Program of Guangxi Provincial Health Bureau in 2008, No. 200835*

PDF

483

被引次数

5

摘要：

背景：后交叉韧带重建中胫骨隧道的定位一直是手术的难点，把计算机导航技术运用到后交叉韧带重建中，希望能提高胫骨隧道定位的精度。
目的： 采用计算机导航系统在重建膝关节后交叉韧带中准确定位胫骨隧道的方法，评价其在后交叉韧带重建中的应用价值。 
方法：甲醛防腐成人下肢标本50侧，切断标本后交叉韧带后分别用聚氨酯海棉粘贴包裹模拟软组织覆盖的完整标本。随机分成两组，分别采用计算机辅助导航系统(导航组)及传统关节镜(对照组)定位胫骨隧道。观察两组标本胫骨隧道的出口位置，透视后测量胫骨隧道的矢状角度及长度，记录透视次数。
结果与结论：导航组胫骨虚拟隧道矢状角度和长度术中定位及术后实测比较差异均无显著性意义(P > 0.05)。导航组术后实测胫骨隧道矢状角度为(61.88±0.94)°、透视次数为(3.0±0.5)次，对照组分别为(52.63±1.04)°及(9.0±2.7)次；导航组隧道出口位于后交叉韧带生理附着区23例，对照组为15例；两组比较差异均有显著性意义(P< 0.05)。结果提示透视导航技术可以辅助后交叉韧带重建手术中胫骨隧道的定位，具有隧道定位准确性高、辐射及手术污染机会减少的特点。

关键词: 计算机导航系统, 后交叉韧带, 重建, 胫骨隧道, 矢状角度

Abstract:

BACKGROUND: Positioning pathway of bony tunnel in tibia during reconstructing posterior cruciate ligament is a difficult part of surgical procedure permanently. As computer assistant navigating system applied in the field of medicine rapidly, we use this technique to elevate accuracy of positioning bony tunnel in tibia and improve the operative effect in reconstruction of posterior cruciate ligament.
OBJECTIVE: To investigate the rational plan of computer navigation system in the reconstruction of posterior cruciate ligament and the accurate positioning methods of tibial tunnel, and to evaluate the application of computer navigation system in the reconstruction of posterior cruciate ligament. 
METHODS: Fifty adult lower limb specimens were collected and randomly divided into two groups, each 25 specimens. The computer navigation system and the traditional arthroscopy system were respectively used for positioning the tibial tunnel reconstructed by adult posterior cruciate ligament. The exit position of tibial tunnel was observed in two groups, the angle between tunnel and the articular surface of tibia was measured through sagittal plane, and the number of fluoroscopy was recorded.
RESULTS AND CONCLUSION: There were no difference between fictitious tunnel angle and virtual tunnel angle (P > 0.05). X-ray at side position showed: the tibial tunnel angle in non-navigation group was (52.63±1.04)°, and that in navigation group was (61.88±0.94)°. The tibial tunnel angle in navigation group was more than 60°, which could effectively avoid the killer turning effect. There were 23 cases of tibial tunnel exit position in effective planned region in navigation group and there were only 15 cases in non-navigation group, which showed that the exit position of tibial tunnel oriented by computer navigation system was closer to the physical insertion point. The fluoroscopy number of navigation groups was 3±0.5, that in non-navigation group was 9±2.7. There were little radiation and surgery pollution in navigation group. Fluoro-based navigation technique could be used for assisting tibial tunnel placement in arthroscopic posterior cruciate ligament reconstruction. It had characteristics such as accurate and reasonable tunnel placement and saving fluoroscopy time.

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