1、ACL重建术手术技术（一）异体骨髌腱骨 重建ACL西南医院关节外科中心西南医院关节外科中心 重庆重庆术前评估n病史n临床查体n膝关节松弛度检测（KT-1000等）n评分系统nLysholm ScalenTegner ScalenIKDC Knee Rating Systemn辅助检查n标准前内、前外侧切口（稍靠近髌腱）n隧道起始点：胫骨结节内侧一指，内侧关节线下方二指髁间窝成型（Notchplasty）n为了准确将移植物置入股骨侧，通常采用髁间窝成型。n避免狭窄髁间窝磨损移植物n2mm髁间窝成型使移植物在屈曲过程中张力过大nffects of notchplasty and femoral t
2、unnel position on excursion patterns of an ffects of notchplasty and femoral tunnel position on excursion patterns of an anterior cruciate ligament graft anterior cruciate ligament graft，ArthroscopyArthroscopy，April 2019 Volume 19 Number April 2019 Volume 19 Number 4.4.n目前常用于重建ACL的生物材料包括n骨髌腱骨（B-PT-B
3、）n腘肌腱（Hamstring）n半腱肌腱(semitendinosus tendon)n跟腱骨(Achilles tendon)等。nNoyes等进行的力学实验证实髌腱强度为正常ACL的168%，单股半腱肌和跟腱分别为70%和49%胫骨隧道 n隧道开口位置在正常ACL胫骨止点的前部：n引起髁间窝碰撞（impingement）n股骨隧道口扩大n可能造成膝关节伸直位丢失角度10或更多n近年观点基本统一，应该位于ACL解剖位置偏后 胫骨侧止点n原ACL印迹的后内部n外侧半月板后角前缘和内侧半月板前角后缘的连线之间中点n外侧半月板前角后缘延长线与内侧胫骨棘突起之间交点n后交叉韧带（PCL）前方7mm
4、的点n侧位X线片描述为胫骨平台前4043%处股骨隧道 n对ACL稳定性影响大n意见尚不统一n在ACL解剖位置偏前n Merchant TC.Comparison of three patellar tendon anterior cruciate Merchant TC.Comparison of three patellar tendon anterior cruciate ligament reconstruction techniques with emphasis on tunnel location and ligament reconstruction techniques wit
5、h emphasis on tunnel location and outcome.Are our results improving?Iowa Orthop J.2019;21:25-30.outcome.Are our results improving?Iowa Orthop J.2019;21:25-30.n在ACL解剖位置偏后nKhalfayan EE,Sharkey PF,Alexander AH,et al.Am J Sports Med.2019 May-Khalfayan EE,Sharkey PF,Alexander AH,et al.Am J Sports Med.201
6、9 May-Jun;24(3):335-41.The relationship between tunnel placement and clinical Jun;24(3):335-41.The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction.results after anterior cruciate ligament reconstruction.n冠状面位置：nBlummsat线10:00和11:00位置对膝关节前后稳定
7、性的影响相同nBlummsat线10:00 位置对膝关节旋转 稳定性更好n2019 2019 Richard OConnor Award PaperRichard OConnor Award Paper：Knee stability and graft function Knee stability and graft function following anterior cruciate ligament reconstruction:Comparison between following anterior cruciate ligament reconstruction:Comparison between 11 oclock and 10 oclock femoral tunnel placement 11 oclock and 10 oclock femoral tunnel placement 隧道角度n股骨隧道与股骨干的角度以及胫骨隧道与胫骨平台的角度也是影响术后膝关节稳定性的重要因素。nIAD+TT=N+TBPnN+7原则n55：TT约50-55mm IAD约23-30mm
