髁间窝形态及胫骨平台倾斜角与后十字韧带胫骨止点撕脱骨折的相关性  

The correlation between posterior cruciate ligament avulsion fracture and intercondylar notch and tibial slope

作　　者：范宁[1] 藏磊[1] 郑永辰[2] 彭永胜[2] 袁硕[1] Fan Ning;Zang Lei;Zheng Yongchen;Peng Yongsheng;Yuan Shuo(Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China;Second Department of Orthopaedics,Beijing Shunyi District Hospital,Beijing 101300,China)

机构地区：[1]首都医科大学附属北京朝阳医院西院骨科,100043 [2]北京市顺义区医院骨二科,101300

出　　处：《中华骨科杂志》2020年第17期1197-1205,共9页Chinese Journal of Orthopaedics

基　　金：1351人才培养计划(CYMY-2017-14)。

摘　　要：目的探讨后十字韧带(posterior cruciate ligament,PCL)胫骨止点撕脱骨折与髁间窝及胫骨平台倾斜角的相关性。方法选取2012年1月至2018年10月收治的成人PCL胫骨止点撕脱骨折患者48例及按年龄和性别匹配的非PCL撕脱骨折的膝损伤患者或健康成人48例。PCL胫骨止点撕脱骨折组男25例,女23例;年龄(54.35±14.06)岁(范围27~82岁)。行膝关节MRI冠状面、矢状面和横断面测量,包括髁间窝角、髁间窝宽度和高度、股骨内外髁宽度、股骨髁宽度、内外侧胫骨平台后倾角、冠状面胫骨平台倾斜角,并计算髁间窝形态指数及髁间窝宽度指数。比较两组形态学参数的差异,将差异有统计学意义的参数纳入多因素分析,通过二分类Logistic回归分析确定PCL撕脱骨折的危险因素。对确定的危险因素采用受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积(the area under the ROC curve,AUC)值来评价其临床诊断效能。测量者的组内和组间测量值的可重复性由组内相关系数(intraclass correlation coefficients,ICC)评估。结果测量者的组内ICC值除冠状面髁间窝高度为0.709、内侧胫骨平台后倾角为0.699、外侧胫骨平台后倾角为0.705外,其他参数范围为0.802~0.980,均具有较好的可重复性;组间ICC值除冠状面髁间窝高度为0.700外,其他参数范围为0.778~0.971。单因素分析显示PCL胫骨止点撕脱骨折组的横断面髁间窝角(52.56°±6.56°)、冠状面髁间窝角(54.81°±7.29°)、横断面髁间窝宽度[(19.62±2.32)mm]、横断面髁间窝形态指数(0.68±0.08)和内侧胫骨平台后倾角(8.27°±3.53°)均明显高于非PCL胫骨止点撕脱骨折组[分别为47.25°±5.62°、50.27°±5.27°、(18.63±2.18)mm、0.62±0.07、6.85°±3.15°]。二分类Logistic回归分析结果显示冠状面髁间窝角(β=0.102,OR=1.108,P=0.030)和内侧胫骨平台后倾角(β=0.151,OR=1.163,P=0.046)为PCL胫骨止点撕脱骨折的危险因素。ROObjective To evaluate whether posterior cruciate ligament(PCL)avulsion fracture was correlated with intercondylar notch and tibial slope.Methods A total of 48 patients with PCL avulsion fracture were compared with 48 age-and sex-matched healthy controls without PCL avulsion fracture from January 2012 to October 2018 in our hospital.There were 25 males and 23 females with an average age of 54.35±14.06 years(range 27-82 years)in PCL avulsion fracture group.MRI of the knee joint were acquired in the sagittal,coronal,and axial sequences.The measurements included intercondylar notch's angle,width,and height,medial/lateral condylar widths,condylar width,medial/lateral posterior tibial slopes and coronal tibial slope.Notch shape index and notch width index were also calculated to adjust for size variations.The predictive accuracy of Risk factors were analyzed using the area under the receiver operating characteristic curve(AUC).The differences of morphological measurements between the two groups were compared.The morphological measurements with statistical significance were included for further multivariate analysis.Risk factors of PCL avulsion fracture were determined by binary logistic regression analysis.The inter-and intra-observer reproducibility of the measurements was determined by the intraclass correlation coefficients(ICC).Results Except for coronal intercondylar notch height(0.709),medial posterior tibial slope(0.699)and lateral posterior tibial slope(0.705),the other intra-observer ICC ranged from 0.802 to 0.980,which indicated that the parameters had desirable reproducibility.Similarly,except for coronal intercondylar notch height(0.700),the other intra-observer ICC ranged from 0.778 to 0.971.Parameters of patients with PCL avulsion fracture,including the axial notch angle(52.56°±6.56°),coronal notch angle(54.81°±7.29°),axial intercondylar notch width(19.62±2.32 mm),axial notch shape index(0.68±0.08)and medial posterior tibial slope(8.27°±3.53°),were all significantly larger than those of the co

关 键 词：后交叉韧带 胫骨骨折 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]