X线动态测量膝前交叉韧带长度变化

Length Change of Anterior Cruciate Ligament by Movement Measuring of Articular Genu on the Lateral Radiographs

目的在侧位X线片下分别测定膝关节屈曲90°及过伸位时前交叉韧带(ACL)股骨等距点(i点)到胫骨等距点(T点)的距离,并比较在2种体位下其长度的变化,评估关节镜结合X线透视双监视法行ACL等距解剖重建的影像学效果。方法门诊随机抽取50名志愿者,行膝关节侧位X线片检查,在PX电子系统下找到屈曲90°及过伸位ACL的i点和T点,测量两点间距离,并比较在屈伸过程中两点长度的变化。结果屈曲90°时i点到T点距离的95%可信区间为(25.43±0.455)mm,最大值为29.22 mm,最小值为20.29 mm;过伸位时i点到T点距离的95%可信区间为(26.90±0.436)mm,最大值为29.76 mm,最小值为23.10 mm;过伸位与屈曲90°时两点间距离之差的95%可信区间为(1.47±0.204)mm,最大值为3.33 mm,最小值为0.47 mm。结论术前X线片测量及术中关节镜结合X线透视双监视法可根据不同个体的差异对ACL的股骨等距点及胫骨等距点行准确定位,可达到生理性等距重建的要求,同时对设备的要求不高,可在大多数医院开展。

Objective To investigate the length change of anterior cruciate ligament from flexion 90° to full extension by lateral radiographs and determine the radiograph effect of ACL two-stakeout anatomy isometric reconstruction in arthroscope with inspectoseope. Methods Fifty volunteers were required to take the lateral radiographs of articular genuses.The length from femoral isometric point to tibial isometric point was measured when these articular genuses were on flexion 90° and on full extension. The length change was compared when articular genus acted from flexion 90° to full extension. Results The average of the distances from femoral isometric point to tibial isometric point on flexion 90° was （25.43±0.455） mm,and the maximal value was 29.22 mm,and the minimal value was 20.29 mm.The average of the distances on full extension was （26.90±0.436） mm, and the maximal value was 29.76 mm,and the minimal value was 23.10 mm. The average of the length change from flexion 90° to full extension was （1.47±0.204） mm, and the maximal value was 3.33 mm,and the minimal value was 0.47 mm.Conclusion ACL two-stakeout anatomy isometric reconstruction is simple to perform and better acquires the accuracy and reliability of the femoral isometric point and the tibial isometric, and meets the demand of individual variation of ACL attachment.Meanwile,the demand of device is simple to satisfy and the technique is easy to perform in most hospitals.