胫骨平台后倾角与运动性前后交叉韧带损伤的相关性研究  

Study on the correlation between posterior tibial slope and athletic anterior and posterior cruciate ligament injury

作　　者：梁锋 费宇翔 孙恒 陈东阳[1,2] 徐志宏[2] 蒋青[1,2] 徐兴全[1,2] LIANG Feng;FEI Yu-xiang;SUN Heng;CHEN Dong-yang;XU Zhi-hong;JIANG Qing;XU Xing-quan(Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,The Affiliated Hospital of Nanjing University Medical School,Nanjing,Jiangsu,210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,江苏省210008 [2]南京大学医学院附属鼓楼医院,江苏省210008

出　　处：《中国骨与关节杂志》2024年第6期430-435,共6页Chinese Journal of Bone and Joint

基　　金：国家自然科学基金面上项目(32271409);南京市卫生科技发展专项基金杰出青年基金项目(JQX20001)。

摘　　要：目的研究前交叉韧带(anterior cruciate ligament,ACL)损伤,后交叉韧带(posterior cruciate ligament,PCL)损伤患者及无膝关节韧带损伤患者之间胫骨平台后倾角(posterior tibial slope,PTS)是否存在差异,并探索易造成ACL、PCL损伤的PTS的临界值。方法回顾分析2018年1月至2023年6月我院收治的34例PCL损伤患者(男27例,女7例)、53例ACL损伤患者(男43例,女10例)以及51例无膝关节韧带损伤患者(男41例,女10例)的资料,在MRI影像矢状位上测量内外侧胫骨平台后倾角(medial and lateral posterior tibial slope,MPTS/LPTS),比较各组后倾角大小差异,并通过绘制受试者工作特征(receiver operating characteristic,ROC)曲线预测PTS临界值。结果ACL损伤组的MPTS[(7.79±2.61)°]及LPTS[(8.98±3.28)°]均大于对照组[(5.82±2.42)°,(5.21±3.45)°;P<0.05],PCL损伤组的MPTS[(3.94±2.60)°]及LPTS[(2.56±2.64)°]均小于对照组(P<0.05);差异有统计学意义。通过绘制ROC曲线,得到ACL损伤组与对照组PTS的截断值为6.15°(MPTS)及5.85°(LPTS);PCL损伤组与对照组PTS的截断值为4.00°(MPTS)及3.30°(LPTS)。通过多因素Logistic回归分析得到:MPTS<4.00°[OR=7.544,P=0.003]和LPTS<3.30°[OR=6.255,P=0.003]是PCL损伤的独立危险因素;MPTS>6.15°[OR=4.405,P=0.014]和LPTS>5.85°[OR=10.284,P<0.001]是ACL损伤的独立危险因素。结论胫骨平台内外侧后倾角大小与ACL及PCL损伤相关,PTS过大是ACL损伤的危险因素,而PTS过小是PCL损伤的危险因素。MPTS>4.00°~<6.15°;LPTS>3.30°~<5.85°可能是对于前后交叉韧带损伤风险较小的PTS范围。Objective To find out if there is any difference in posterior tibial slope(PTS)among patients with anterior cruciate ligament(ACL)injury,patients with posterior cruciate ligament(PCL)and patients without knee ligament injury.And to explore the threshold of PTS which is likely to cause ACL injury and PCL injury.Methods A retrospective study was performed on the patients who were admitted to our hospital from January,2018 to June,2023.There were 34 patients with PCL injury(27 males and 7 females),53 patients with ACL injury(43 males and 10 females)and 51 patients without knee ligament injury as control(41 males and 10 females).The medial and lateral posterior tibial slope(MPTS/LPTS)was measured in sagittal MRI image,and the differences in posterior tibial slope were compared among groups.The thresholds of PTS were calculated by receiver operating characteristic(ROC)curves.Results MPTS(7.75±2.58)°and LPTS(8.38±2.94)°in the ACL injury group were higher than those in the control group[(5.71±2.27)°,(5.03±3.51)°,P<0.05];the MPTS in the PCL injury group(3.94±2.67)°and LPTS(2.07±2.40)°were both smaller than the control group(P<0.05);the difference was statistically significant.By the ROC curve,the cut off values of PTS of the ACL injury group and control group were 6.15°(MPTS)and 5.73°(LPTS);the cut off value of the PTS of the PCL injury group and the control group was 4.00°(MPTS)and 3.30°(LPTS).Multivariate Logistic regression analysis showed that MPTS<4.00°[OR=7.544,P=0.003]and LPTS<3.30°[OR=6.255,P=0.003]were independent risk factors for PCL injury;MPTS>6.15°[OR=4.405,P=0.014]and LPTS>5.85°[OR=10.284,P<0.001]were independent risk factors for ACL injury.Conclusions The medial and lateral posterior tibial slope is related to ACL and PCL injuries.Excessive PTS is a risk factor for ACL injury,while small PTS is a risk factor for PCL injury.4.00°<MPTS<6.15°and 3.30°<LPTS<5.73°may be the range of PTS with less risk of anterior and posterior cruciate ligament injury.

关 键 词：前交叉韧带损伤 后交叉韧带损伤 胫骨平台后倾角 

分 类 号：R873[医药卫生—运动医学]