陈旧性前交叉韧带断裂膝关节退变影像学研究

Imaging study of degeneration in knee after old rupture of anterior cruciate ligament

目的探讨陈旧性前交叉韧带（ACL）断裂后股骨髁间窝变化特点,为ACL个体化解剖重建手术方案提供参考。方法选择2013年7月~2014年10月承德医学院附属医院骨科收治陈旧性ACL断裂患者40例,均在伤后6个月以上进行手术,以患膝为观察组,健膝为对照组。术前拍摄双膝MR,测量股骨髁宽度（EW）、髁间窝宽度（ICW）和高度（ICH）、髁间窝宽度指数（NWI）及髁间窝形态指数（NSI）,进行组间比较,并进行ICW与断裂时间的相关性分析。结果观察组ICW值为（14.50±0.88）mm,对照组为（17.19±1.83）mm,两组比较,差异有高度统计学意义（P〈0.01）。观察组ICH值为（20.78±1.69）mm,对照组为（21.29±1.71）mm,两组比较,差异无统计学意义（P〉0.05）。观察组EW值为（74.42±2.39）mm,对照组为（74.92±2.42）mm,两组比较,差异无统计学意义（P〉0.05）。观察组NSI值为（0.70±0.08）,对照组为（0.81±0.13）,两组比较,差异有高度统计学意义（P〈0.01）。观察组NWI值为（0.20±0.01）,对照组为（0.23±0.03）,两组比较,差异有高度统计学意义（P〈0.01）。患者ICW差值（健侧-患侧）为（2.69±1.56）mm,患膝ACL断裂时间为（32.40±18.25）个月,二者呈显著正相关关系（r=0.951,P〈0.01）。结论 ACL断裂后股骨髁间窝变窄,主要发生ICW改变,并随时间延长呈加重趋势。在陈旧性ACL重建中应采用个体化重建原则,避免韧带与髁间窝侧壁的撞击。

Objective To investigate the change of femoral intercondylar fossa after old rupture of anterior cruciate ligament（ACL）, in order to provide reference for operation plan of ACL individual anatomy reestablishment. Methods 40 cases of patients with old rapture of ACL treated in Department of Orthopedics, Affiliated Hospital of Chengde Medical University from July 2013 to October 2014 were selected. All patients were given surgery after injury more than6 months. The knees with old rupture of ACL were taken as the observation group, and the healthy knees were taken as the control group. Before surgery all patiens were given MR image, the epicondylar width（EW） and intercondylar width（ICW）, intercondylar height（ICH）, notch shape index（NSI） and notch width index（NWI） were measured and compared between the two groups, and the relationship between ICW and the time of fracture was analyzed. Results The values of ICW in the observation group and the control group were（14.50±0.88） and（17.19±1.83） mm respectively,with statistically significant difference（P〈0.01）. The values of ICH in the observation group and the control group were（20.78±1.69） and（21.29±1.71） mm respectively, the difference was not statistically significant（P〉0.05）. The values of EW in the observation group and the control group were（74.42 ±2.39） and（74.92±2.42） mm respectively, the difference was not statistically significant（P〉0.05）. The values of NSI in the observation group and the control group were（0.70 ±0.08） and（0.81 ±0.13） respectively, with statistically significant difference（P〈0.01）. The values of NWI in the observation group and the control group were（0.20±0.01） and（0.23±0.03） respectively, with statistically significant difference（P〈0.01）. The deviation of ICWs（healthy side- injured side） of patients was（2.69 ±1.56）mm, and the time of ruptured ACL in injured knees was（32.40±18.25） months, there was significant positive correlation between them（r=0.951, P〈0.01）. Conclusion After the rupture of ACL, the ICW changes, and femoral intercondylar fossa has stenosis, which aggravated with the time. Principle of individualized reconstruction should be taken in the reestablishment of ruptured ACL, and avoid the hit against between ligament and lateral wall of condyle fossa.