319例不同病程前交叉韧带断裂患者胫骨髁间棘几何形态比较

The Geometry Comparison of Tibial Intercondylar Spine in Different Courses of 319 Anterior Cruciate Ligament Rupture:A Study of 319 Cases

目的:了解不同病程前交叉韧带(ACL)断裂患者胫骨髁间棘几何形态的差异,探讨其对ACL传统单束重建和解剖双束重建的临床意义。方法:2005年5月24日至2008年2月27日,用GE Healthcare Centricity RIS/PACKS系统对319例ACL断裂患者的胫骨平台内、外侧髁间棘的几何形态进行了测量,测量指标包括内侧髁间棘垂直高度、外侧髁间棘垂直高度、内外侧髁间棘顶点连线中点处的垂直高度、胫骨平台的内外宽度和内外侧髁间棘基底宽度之和。比较病程分别为≤3个月、>3个月且≤6个月、>6个月且≤12个月和>12个月的各组ACL断裂患者髁间棘形态测量值的差异。结果:与病程≤3个月的ACL断裂患者相比,病程>3个月且≤6个月的患者髁间棘几何形态改变不明显,病程>6个月且≤12个月的患者外侧髁间棘高度显著增加,病程>12个月的患者内、外侧髁间棘高度均显著增加。结论:ACL断裂患者随病程延长髁间棘几何形态有所改变。对病程长于12个月的患者,应考虑其胫骨内、外侧髁间棘增高对ACL重建术中胫骨骨道定位和ACL重建术后增生的髁间棘对移植物的撞击的影响。

Objective To study the influence of different courses of anterior cruciate ligament（ACL） rupture patients on the geometry shapes of the medial and lateral tibial intercondylar spines.Methods GE Healthcare Centricity RIS/PACKS System was used to measure the geometry shapes of the medial and lateral tibial intercondylar spines of 319 ACL deficient cases from May 24,2005 to February 27,2008.The measures included the vertical height of the medial and lateral intercondylar spine,the vertical height of the middle point of the line connecting the tips of the medial and lateral intercondylar spines,the mediolateral width of the tibia plateau,the summation of the width of the medial and lateral intercondylar spines bases.The intercondylar shape＇s differences among ACL deficient patients in disease courses that equal or less than 3 months,more than 3 months to equal or less than 6 months,more than 6 months to equal or less than 12 months and more than 12 months groups were compared.Results Compared with cases whose course of disease was equal or less than 3 months,the geometry shape of the intercondylar spines had no change in the cases whose course of disease was 3 to 6 months.The vertical height of the lateral intercondylar spine increased if the course of disease were more than 6 months and equal or less than 12 months.For the case that the the course of disease were more than 12 months,the shapes of the medial and lateral intercondylar spines increased significantly.Conclusions For ACL deficient patients,with the elongation of the course of disease,the changes of the shape of the intercondylar spine would be happened.For ACL deficient patients with longer courses of diseases,especially more than 1 year,the influence of the intercondylar shape changes on the tibia tunnel location and the graft impingement during conventional single-bundle and anatomic double-bundle ACL reconstructions should be taken into account.