胫骨后倾与非接触性前交叉韧带断裂的关系及其对关节稳定性的影响

Effects of posterior tibial slope on non-contact anterior cruciate ligament rupture and stability ofanterior cruciate ligament rupture knee

目的观察胫骨后倾（PTS）与非接触性前交叉韧带（ACL）断裂的关系及PTS对膝关节稳定性的影响。方法回顾性研究2008年1月至2012年10月非接触性ACL断裂患者150例，非ACL断裂的150例患者为对照；X线侧位片测量PTS角度，Laehman和轴移试验评估关节稳定性，并行统计学分析。结果ACL断裂组PTS角度为（9．5±2．2）°，对照组为（6．6±1．8）°，两组之间有明显差异，但仅见于女性患者；PTS增加对Lachman试验无明显影响，却明显影响轴移试验。结论PTS增加（〉6．6°）的女性人群，ACL损伤的风险要明显高于PTS相对小的人群（〈6．6°）；胫骨过度后倾会降低ACL断裂患者的膝关节轴向稳定性，而PTS较小患者，轴移试验阴性不能完全排除ACL损伤。

Objective To retrospectively explore the correlation between anterior cruciate ligament （ACL）-ruptured knees, stability of ACL-rupture knee and posterior tibial slope （PTS）. Methods From January 2008 to October 2012, 150 knees with ACL rupture underwent arthroscopic surgery for ACL reconstruction. A control group was established for subjects undergoing arthroscopic surgery without ACL rupture during the same period. PTS was measured on a digitalized lateral radiograph. Lachman and mechanized pivot shift tests were performed for assessing the stability of knee. Results There was significant difference （P = 0. 007 ） in PTS angle between the patients with ACL rupture （9. 5 ±2. 2 degrees） and the control group （6. 6 ±1.8 degrees）. Only among females, increased slope of tibial plateau had effect on the Lachman test. There was a higher positive rate of pivot shift test in patients of increased posterior slope in the ACL rupture group. Conclusion Increased posterior tibial slope （ 〉 6. 6） appears to contribute to non-contact ACL injuries in females. And the changes of tibial slope have no effect upon the Lachman test. However, large changes in tibial slope affect pivot shift.