Objective: To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel.
Methods: The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups ( P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up.
Results: The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant ( P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups ( P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group ( P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values ( P<0.05), but there was no significant difference between the two groups ( P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values ( P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups ( P>0.05).
Conclusion: Computer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.
目的: 比较计算机导航辅助与单纯关节镜下重建后交叉韧带（posterior cruciate ligament，PCL）胫骨骨道的术中应用效果。.
方法: 回顾分析2021年6月—2022年6月收治且符合选择标准的73例PCL撕裂患者临床资料，其中34例采用导航辅助关节镜下行PCL胫骨骨道重建（导航组），39例采用单纯关节镜下行PCL胫骨骨道重建（对照组）。两组患者性别、年龄、身体质量指数、损伤侧别、受伤至手术时间及术前后抽屉试验、膝关节活动度（range of motion，ROM）、Tegner评分、Lysholm评分、国际膝关节文献委员会（IKDC）评分等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组围术期指标（手术时间及导针钻孔次数）；于术后1 d MRI上测量移植物与胫骨骨道间角度及冠状位、矢状位、横断位上胫骨骨道出口位置；术前及末次随访时采用膝关节ROM、Tegner评分、Lysholm评分及IKDC评分评价临床疗效。.
结果: 导航组手术时间较对照组短，术中导针钻孔次数较对照组少，差异均有统计学意义（ P<0.05）。两组患者均获随访，随访时间12～17个月，平均12.8个月。均未见血管神经损伤、下肢深静脉血栓形成及感染等围术期并发症。随访期间两组患者均无再损伤，无需进行翻修手术。两组胫骨骨道出口位置测量数据显示，冠状位、矢状位及横断位上差异均无统计学意义（ P>0.05）；但导航组移植物与胫骨骨道间角度大于对照组（ P<0.05）。末次随访时，导航组后抽屉试验阴性、1+、2+、3+ 分别为30、3、1、0例，对照组分别为33、5、1、0例，均较术前显著改善（ P<0.05），但两组间差异无统计学意义（ P>0.05）。两组膝关节ROM、Tegner评分、Lysholm评分及IKDC评分均较术前显著改善（ P<0.05），但两组间各指标手术前后差值比较差异均无统计学意义（ P>0.05）。.
结论: 计算机导航辅助关节镜下PCL胫骨骨道重建可快速且准确地制备具有良好位点及方向的骨道，术后功能评分与单纯关节镜下行PCL胫骨骨道重建效果相当。.
Keywords: Posterior cruciate ligament reconstruction; arthroscopy; computer navigation; tibial tunnel.