髁间窝外侧壁后软骨缘顶点在评估前交叉韧带股骨骨道位置中的临床应用

The Role of the Apex of the Deep Cartilage in Assessing Femoral Tunnel Position for Anterior Cruciate Ligament Reconstruction

目的：以髁间窝外侧壁后软骨缘顶点（the apex of the deep cartilage,ADC）为标志,研究术后CT与镜下评估前交叉韧带（anterior cruciate ligament,ACL）股骨骨道位置时两种方法的一致性。方法：2014年5月至2016年5月,关节镜下前交叉韧带重建患者36例纳入本研究。所有患者术中均依据完好的股骨残端进行中心点定位。屈膝90°,测量ADC至前骨缘的水平距离（L_1）以及与骨道中心点的水平距离（l_1）,计算l_1/L_1比值（P_1）,同时测量骨道中心点与下骨缘的距离（D_1）。术后在CT片上测量ADC至前骨缘的水平距离（L_2）以及与骨道中心点的水平距离（l_2）,计算l_2/L_2比值（P_2）,同时测量骨道中心点与下骨缘的距离（D_2）。应用线性回归、Pearson相关和Bland-Altman分析比较镜下评估与CT评估的一致性。结果：P1=44.07%±2.22%（41.1%%~49.5%）,D_1=6.2±0.5 mm（5.5~7 mm）。P_2=44.92%±2.27%（40.9%~50.2%）,D_2=6.3±0.6 mm（5.1~7.5 mm）。P_1和P_2（r=0.99,P〈0.001）、D_1和D_2（r=0.69,P〈0.001））分别呈正相关,且线性关系显著（P〈0.001）。Bland-Altman图显示一致性较好。结论：以ADC为标志评估ACL股骨骨道位置,术后CT与镜下评估的一致性较好。

Objective To examine the consistency between postoperative CT scan and intraoperative arthroscopic measurement in evaluating femoral tunnel position for anterior cruciate ligament（ACL）reconstruction,both using the apex of the deep cartilage（ADC）as the marker. Methods A total of 36 patients undergoing anatomic arthroscopic ACL reconstruction in our institute between May 2014 and 2016 were recruited. The position of the center of femoral tunnel was decided in the complete femoral stub. Then the length from the ADC to the anterior cartilage margin（L1）and to the center of femoral tunnel（l1）,as well as the center to the distal cartilage margin（D1）were measured under arthroscopy and on post-operative CT scan（L2,l2 and D2）. Moreover,P1 and P2were calculated through l1/L1 and l2/L2. Linear regression,Pearson correlation and Bland-Altman analysis were performed to evaluate the consistency between the two measurements of P and D respectively. Results P1=44.07% ± 2.22%（41.1%-49.5%）,D1=6.2 ± 0.5 mm（5.5-7 mm）. P2=44.92%± 2.27%（40.9%-50.2%）,D2=6.3 ± 0.6 mm（5.1-7.5 mm）. A positive correlation was detected between P1 and P2（r=0.99,P0.001）,as well as D1 and D2（r=0.69,P〈0.001）,both with significances in linear regression（P〈0.001）. Bland-Altman plot also showed excellent consistency. Conclusions When using the ADC as the marker,an excellent consistency was found between postoperative CT scan and intraoperative arthroscopic measurements in evaluating femoral tunnel position for ACL reconstruction.