胫骨髁间隆起形态与非接触性前交叉韧带损伤的相关性分析  

Correlation between tibial intercondylar eminence morphology and non-contact anterior cruciate ligament injury

作　　者：李盼盼 青浩渺[2] 任思勰 王远军 蒋华[3] LI Panpan;QING Haomiao;REN Sixie;WANG Yuanjun;JIANG Hua(Department of Radiology,Chengdu Second People's Hospital,Chengdu,Sichuan 610017,P.R.China;Department of Radiology,Sichuan Cancer Hospital,Chengdu,Sichuan 610041,P.R.China;Department of Orthopaedics,Chengdu Second People's Hospital,Chengdu,Sichuan 610017,P.R.China)

机构地区：[1]成都市第二人民医院影像科,成都610017 [2]四川省肿瘤医院影像科,成都610041 [3]成都市第二人民医院骨科,成都610017

出　　处：《华西医学》2023年第4期536-542,共7页West China Medical Journal

摘　　要：目的 探讨胫骨髁间隆起形态与非接触性前交叉韧带(anterior cruciate ligament, ACL)损伤的相关性,为ACL损伤的预防及风险因素识别提供一定理论依据。方法 回顾性分析2017年1月-2021年10月成都市第二人民医院就诊的401例患者的膝关节X线片,其中男219例,女182例;经关节镜或手术证实为非接触性ACL损伤断裂的患者180例,经骨科专科体格检查和MRI确认ACL正常的对照组患者221例。测量胫骨内、外侧髁间隆起高度及髁间隆起宽度,分析ACL损伤的风险因素。结果 男性ACL断裂患者胫骨内侧髁间隆起高度及髁间隆起宽度均低于正常对照组(P<0.05),logistic回归分析表明胫骨髁间隆起宽度变窄是男性ACL损伤的危险因素(P<0.05),受试者操作特征(receiver operating characteristic, ROC)曲线表明其诊断阈值为11.40 mm,曲线下面积及95%置信区间(confidence interval, CI)为0.851(0.797,0.896),灵敏度72.81%,特异度84.76%。女性ACL损伤断裂患者的胫骨内侧髁间隆起高度及髁间隆起宽度均低于正常对照组(P<0.05),logistic回归分析表明两者数值变小是女性ACL损伤的危险因素(P<0.05),ROC曲线表明胫骨内侧髁间隆起高度对女性ACL损伤的诊断阈值为8.30 mm,曲线下面积及95%CI为0.684(0.611,0.751),灵敏度63.64%,特异度72.41%,胫骨髁间隆起宽度的诊断阈值为11.30 mm,曲线下面积及95%CI为0.699(0.627,0.756),灵敏度89.39%,特异度47.41%。结论 胫骨髁间隆起宽度是男性非接触性ACL损伤的影响因素及有效预测指标,其数值的降低使男性ACL损伤风险增加。胫骨髁间隆起宽度及内侧髁间隆起高度是女性非接触性ACL损伤的影响因素,两者数值越小则女性ACL损伤风险越大;胫骨髁间隆起宽度及内侧髁间隆起高度可能是女性非接触性ACL损伤的预测指标,需进一步研究证实。Objectivee To analyze the correlation between the morphology of tibial intercondylar eminence and non-contact anterior cruciate ligament(ACL)injury,and provide a theoretical basis for the prevention and risk identification of ACL injury.MethodsA retrospective analysis was conducted on the knee radiographs of 401 patients admitted to the Chengdu Second People's Hospital between January 2017 and October 2021,including 219 males and 182 females.Non-contact rupture of ACL was observed in 180 patients and confirmed by arthroscopy or surgery,while the remained 221 patients were confirmed to have normal ACL by physical examination and MRI.The heights of medial and lateral tibial intercondylar eminence and the width of tibial intercondylar eminence of the 401 patients were measured,and the risk factors of ACL injury were analyzed.Results The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in male patients with ACL fracture than those in the male control group with statistical significance(P<0.05).Logistic regression analysis showed that a narrow width of tibial intercondylar eminence was a risk factor of ACL injury in males(P<0.05).The receiver operating characteristic(ROC)curve showed that the diagnostic threshold was 11.40 mm,the area under the curve(AUC)was 0.851[95%confidence interval(CI)(0.797,0.896)],the sensitivity was 72.81%,and the specificity was 84.76%.The height of medial tibial intercondylar eminence was lower and the width of tibial intercondylar eminence was smaller in female patients than those in the female control group with statistical significance(P<0.05).Logistic regression analysis showed that both a low height of medial tibial intercondylar eminence and a narrow width of tibial intercondylar eminence were risk factors of ACL injury in females(P<0.05).For the width of medial tibial intercondylar eminence,the ROC curve showed that the diagnostic threshold was 8.30 mm,and the AUC was 0.684[95%CI(0.611,0.751)],the sensitivity and speci

关 键 词：胫骨髁间隆起 前交叉韧带 膝关节 X线片 

分 类 号：R687.3[医药卫生—骨科学]