前交叉韧带单束解剖重建术股骨隧道定位的X线评估  

Roentgenologic evaluation of femoral tunnel positioning in anterior cruciate ligament single-bundle anatomical reconstruction

作　　者：谢凯罗 董伊隆[1] 张力成[1] 

机构地区：[1]温州医科大学附属第三医院,浙江瑞安325200

出　　处：《中医正骨》2015年第10期11-14,共4页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨应用X线片评估前交叉韧带(anterior cruciate ligament,ACL)单束解剖重建术股骨隧道定位的可行性。方法:选取57例因ACL断裂接受ACL单束解剖重建术的患者,在术后患侧膝关节标准正位片上测量股骨髁长度ML、移植物股骨止点至股骨外髁外缘的距离NL及膝关节线与股骨隧道中心线的夹角α,在侧位片上测量Blumensaat线的长度BL、移植物股骨止点至股骨髁间凹顶的距离AL及股骨干长轴与股骨隧道中心线的夹角β,以X线片上移植物股骨端在髁间窝处的中心点作为移植物股骨止点。为消除X线片放大率的影响,将所测得的长度转换成百分数,以NL/ML×100%表示移植物股骨止点在正位片上的位置,AL/BL×100%表示移植物股骨止点在侧位片上的位置。将所测数据(解剖重建组)与我们以往采用ACL单束解剖重建术治疗并完成随访的47例患者的数据进行比较;47例患者均已采用国际膝关节文献委员会(the international knee documentation committee,IKDC)膝关节韧带损伤评分量表评定疗效,其中38例IKDC评分>90分(IKDC>90分组),9例IKDC评分<90分(IKDC<90分组)。结果:解剖重建组NL/ML×100%、AL/BL×100%、α角及β角分别为(55.71±4.78)%、(30.13±5.26)%、47.90°±3.57°、29.50°±4.52°。解剖重建组和IKDC>90分组NL/ML×100%、AL/BL×100%、α角及β角比较,组间差异均无统计学意义(t=1.201,P=0.233;t=0.389,P=0.698;t=1.879,P=0.063;t=1.803,P=0.075)。解剖重建组与IKDC<90分组的NL/ML×100%比较,差异无统计学意义(t=1.511,P=0.136);解剖重建组的AL/BL×100%、α角及β角均小于IKDC<90分组(t=9.067,P=0.000;t=15.361,P=0.000;t=6.967,P=0.000)。结论:通过在术后X线片上进行测量,可评估ACL单束解剖重建术股骨隧道定位的准确性。Objective： To explore the feasibility of roentgenologic evaluation of femoral tunnel positioning in anterior cruciate ligament（ ACL） single- bundle anatomical reconstruction. Methods： Fifty- seven patients who received ACL single- bundle anatomical reconstruction for treatment of ACL rupture were selected. After the surgery,the length of femoral condyle（ ML）,the distance between femoral ending point of graft and lateral border of femoral lateral condyle（ NL） and the angle（ α） between the knee- joint line and the centre line of femoral tunnel were measured on the standard anteroposterior X-ray film of affected knee; while the length of Blumensaat line（ BL）,the distance between femoral ending point of graft and the top of femoral intercondyloid fossa（ AL） and the angle（ β） between the macroaxis of femoral shaft and the centre line of femoral tunnel were measured on the lateral X-ray film,with use of the central point of femoral ends of graft in intercondyloid fossa on the X-ray film as femoral ending point of graft. In order to eliminate the influence of magnification of X-ray film,above lengths were converted into percentage. NL / ML × 100% represented the location of femoral ending point of graft on the anteroposterior X-ray film,and AL / BL × 100% represented the location of femoral ending point of graft on the lateral X-ray film. Then the data（ anatomic reconstruction group） were compared with previous data of 47 patients who were treated with ACL single bundle anatomical reconstruction and completed the follow-up visit. The therapeutic effects had been evaluated in the 47 patients by using the knee ligament injury rating scale issued by the international knee documentation committee（ IKDC）,the IKDC score of 〉90 points was found in 38 patients（ IKDC 〉90 points group） and the IKDC score of 〈90 points was found in 9 patients（ IKDC 〈90 points group）. Results： NL / ML × 100%,AL / BL ×100%,angle α and angle β in anatomic reconstruction group were 55.

关 键 词：前交叉韧带重建 关节镜检查 体层摄影术 X线 股骨隧道定位 

分 类 号：R687.4[医药卫生—骨科学] R816.8[医药卫生—外科学]