| ObjectiveTo investigate the feasibility of the digital navigation template for Femoral tunnel stereotaxy in posterior cruciate ligament reconstruction.compared with Free-hand,Arthroscopic method verified the accuracy of the digital navigation template and to evaluate the value of the digital navigation template in posterior cruciate ligament reconstruction.Methods1. One case of knee specimens was randomly selected,using Mimics^ Reverse engineering software to reconstruct of the knee model, and to stereotaxy the centre point of posterior cruciate ligament femoral,tibial tunnel,design femoral entry tunnel,observe the tunnel shape and export position.design the femoral tunnel navigation template and manufactur it by rapid prototyping(STA technique).2.40 cases of knee were randomly divided into two groups, one group used digital navigation template stereotaxy Femoral tunnel and the other group stereotaxy Femoral tunnel by a clinical experienced doctor through Free-hand method.two groups had the same stereotaxy criteria. A CT scan of the knee in extension position was performed,CT datas lead into Mimics software and to survey femoral tunnel center point clock position,the distance between center point and the edge of medial femoral condyle cartilage and the angle between the femoral tunnel and the medial wall of medial femoral condyle,.Further more,20 case patients with ruptured of posterior cruciate ligament were shelcted in a row,the same stereotaxy criteria was used in reconstructed posterior cruciate ligament by Arthroscopic method. A CT scan of the knee in extension position was performed after the operation,CT datas lead into Mimics software and to survey femoral tunnel center point clock position,the distance between center point and the edge of medial femoral condyle cartilage and the angle between the femoral tunnel and the medial wall of medial femoral condyle. To compared the accuracy of three method and the size of the angle between the femoral tunnel and the medial wall of medial femoral condyle.3. To select patients with posterior cruciate ligament rupture, design the digital navigation template for Femoral tunnel stereotaxy in posterior cruciate ligament reconstruction, survey the femoral tunnel accuracy after the operation,through followed up evaluate the knee function and clinical effect.Results1. The digital navigational template with corresponding knee intercondylar fossa were found to be highly coincide and accurate,the export position of femoral tunnel was not involving the surface of the patellofemoral joint.2.In the femoral intercondylar fossa clock frame of axes,the navigational template group femoral tunnel center point average deflexion angle was 45.34°(standard deviation 1.27°,range 42.96°～48.12°),the free-hang group was average deflexion angle 47.61°(standard deviation4.07°,range 37.62°～55.05°),the arthroscopy group average deflexion angle was 46.96°(standard deviation4.06°,range 39.53°～53.34°).three methods through single sample t-test by SPSS15.0:the navigational template group (P=0.250>0.05) femoral tunnel center point deflexion angle In the femoral intercondylar fossa clock frame of axes after postoperation was no statistical significance compared with preoperation design, the free-hand group (P=0.047< 0.05) and the arthroscopy group (P=0.028<0.05) femoral tunnel center point deflexion angle In the femoral intercondylar fossa clock frame of axes after postoperation was statistical significance compared with preoperation reference criteria;in the distance between center point and the edge of medial femoral condyle cartilage, the average distance of the navigational template group femoral tunnel between center point and the edge of medial femoral condyle cartilage was 8.55mm(standard deviation 0.11mm,range 8.35mm～8.83mm), the free-hand group was average distance 9.93mm (standard deviation1.13mm,range 7.5mm～12.2mm), the arthroscopy group average deflexion angle was 9.74mm (standard deviation1.24mm,range 7.3mm～11.76mm). three methods through single sample t-test by SPSS15.0:the distance of navigational template group (P=0.052>0.05) between center point and the edge of medial femoral condyle cartilage after postoperation was no statistical significance compared with preoperation design, the distance of free-hand group (P=0.000<0.05) and the arthroscopy group (P=0.000 <0.05) between center point and the edge of medial femoral condyle cartilage after postoperation was statistical significance compared with preoperation reference criteria. So the accuracy of the navigational template group assisted femoral tunnel stereotaxy higher than free-hand group and the arthroscopy group.3.1n the angle between the femoral tunnel and the medial wall of medial femoral condyle, the navigational template group was no statistical significance through paired sample t-test(p=0.399>0.05),there was no change between preoperation and postoperation measured,the average was 117.70°(range 110.59°～123.93°). the free-hand group average angle was 97.06°(range 84.53°～117.63°) and the arthroscopy group average angle was 98.44°(range 88.49°～119.54°).so the navigational template group increased the angle between the femoral tunnel and the medial wall of medial femoral condyle was more obvious,it was convenient for polished the edge of femoral tunnel to reduce the acute angle effect.4.Digital navigational template for femoral tunnel stereotaxy in posterior cruciate ligament reconstruction was accuracy,having a good clinical effdct.Conclusion1. Digital navigational template technology provide a new method for femoral tunnel stereotaxy in posterior cruciate ligament reconstruction.2. Digital navigational template technology for femoral tunnel stereotaxy in posterior cruciate ligament reconstruction was more accuracy and moer practical for clinical.3. Digital navigational template technology avoid the subjectivity of doctors only rely on the eye or clinical experience to stereotaxy, it can shorten the time of surgery and leaning and applicable to primary doctors to learn and master.
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