下肢应力像评价膝关节后向不稳定临床研究

Comparison Analysis of Stress Radiography for the Evaluation of Posterior Knee Laxity

目的:探讨采用下肢应力像测量膝关节后向不稳程度的可信度,并比较其与KT-1000和后抽屉试验两种测试方法的相关性。方法:从2008年10月至2009年6月,共34例患者诊断为后交叉韧带损伤或多发韧带损伤(不包括前交叉韧带损伤),接受手术治疗前(其中6例为多发韧带损伤重建术后二次手术取内固定患者),麻醉下分别采用Telos装置(TelosGmbH,Marburg,Germany)拍摄膝关节应力像、KT-1000(MEDmetricCorporation,SanDiego,California)和后抽屉试验进行测量。由不同研究者分别对应力像进行测量,采用统计学分析计算下肢应力像评价胫骨近端后向不稳定的组内相关系数,讨论其临床应用可信度,并与KT-1000和后抽屉试验结果进行比对。结果:麻醉下采用Telos装置拍摄膝关节应力像所测得数据的可信度组内相关系数(ICCs)为0.992,可重复性组内相关系数为0.991。Telos装置拍摄应力像的数据测量结果与KT-1000测量结果无显著性差异。应力像测量与后抽屉试验检查结果:应力像计算胫骨相对于股骨的后向位移在5～10mm时,后抽屉试验符合率为20%;后向位移在10～15mm时,后抽屉试验符合率为71.4%。结论:KT-1000测量数据与Telos装置拍摄膝关节应力像的测量数据在评价膝关节后向不稳定中无显著差异。随膝关节后向不稳定程度加重,后抽屉试验检查结果的准确度逐渐提高。

Objective Stress radiography provides an objective tool to measure posterior knee instability. This studywas conducted to evaluate the intraobserver and interobserver reliability of measurements using Telos device toquantify posterior knee instability,compared with KT-1000 and PDT test for consistency analysis. Methods FromOctober 2008 to June 2009,68 stress radiographs in 34 patients with posterior knee instability were taken using Telosdevice. The amount of posterior displacement on the radiographs was measured independently by 2 surgeons on 2separate occasions. Changes in intraclass correlation coefficients（ICCs）were examined to assess the intraobserver and interobserver reliability of the measurement,and were compared with those from KT-1000 and PDT test for consistency analysis. Results Intraobserver ICC was 0.992,while interobserver ICC was 0.991. There was no significant difference between Telos and KT-1000 in pair-t test. The data from Telos device was consistent with KT-1000. The coincidentratio of PDT test was 20% while the posterior displacement of the tibia calculated on stress radiography was 5-10 mm.The coincident ratio of the PDT was 71.4% while the posterior displacement of the tibia calculated from stress radiography was 10-15 mm. Conclusion Using Telos device for stress radiograph provides a reproducible method toquantify posterior knee instability,and the consistency between Telos divece and KT-1000 was reliable. The coincidentratio of the PDT test with stress radiography increased when the posterior displacement of the tibia from stress viewbecame more severe.