膝关节三维CT重建评估住院医师嵴发生率

Evaluation of Resident Ridge Rate Using 3D Reconstruction of Knee CT Scan

目的：探讨关节镜下前交叉韧带（ACL）重建术中使用住院医师嵴作为股骨端定位骨性标志的临床可行性。方法：对2011年~2015年间在我院行膝关节CT三维重建的患者中,选取80例,年龄4~81岁,男性53人,女性27人,依照年龄分为4组,A组（4~12岁）、B组（13~30岁）、C组（31~45岁）、D组（45~81岁）,其中B组和C组为我科前交叉韧带断裂拟手术患者,各组20例。分析每组膝关节髁间窝外侧嵴（1ateral intercondylar ridge）即住院医师嵴（resident ridge）三维CT重建之发生率及镜下观察结果。结果：4组患者住院医师嵴发生率：A组0%,B组15%,C组15%,D组45%,组间比较差异有统计学意义（P〈0.05）,住院医师嵴的发生率与患者的性别无相关性（P〉0.05）,与年龄有相关性（P〈0.05）。B组和C组全部患者在关节镜下采用股骨外侧髁内侧壁后1/3定位ACL股骨止点足印区的原则,行有限髁间窝清理后,结果显示,术前三维CT重建证实存在住院医师嵴的患者,术中却未被发现,但在2组患者均能发现位于股骨外髁内侧壁股骨止点足印区内有一条白色致密纤维切迹。住院医师嵴和白色致密纤维切迹无相关性（P〉0.05）。结论：住院医师嵴的发生率与患者的性别无相关性,与年龄有相关性,可能与前交叉韧带股骨止点前界受到应力的持续刺激有关,还需进一步研究证实。关节镜下前交叉韧带重建术中,使用住院医师嵴作为股骨端个体化骨性定位标志尚需临床进一步研究。在B组和C组患者术中确认的白色致密纤维切迹,即ACL股骨足印区致密纤维切迹,可以作为ACL重建术中股骨隧道的个体化非骨性定位参考。

Objective To explore the clinical feasibility of using a resident ridge as a bony land- mark for the femoral tunnel position in arthroscopic anterior cruciate ligament （ACL）reconstruction. Method Eighty patients aged from 4 to 81（53 male and 27 female）receiving CT 3D reconstruction of knee joint in our hospital from 2011 to 2015 were selected and randomly divided into Group A（4y- 12y）,Group B（13y-30y）,Group C（31y-45y）and Group D（45y-81y）,each of 20. The patients of Group B and C were to undergo surgeries with anterior cruciate ligament（ACL）rupture. The lateral intercondy- lar ridge of knee joint, i.e. the resident ridge found in 3D reconstruction of knee CT scan and under the arthroscopy were recorded and compared. Results The resident ridge detection rate in Group A,B, C,and D was 0%, 15%, 15% and 45% respectively,with significant differences among the four groups （P〈0.01）. However, the rate had no correlation with gender,but a correlation with age（P〈0.05）. Un- der the arthroscopy, following the principle of positioning footprint area of ACL femoral attachment at the 1/3 posterior of medial wall of lateral condyle femur for all patients of Groups B and C ,upon limit- ed intercondylar debridement, resident ridges confirmed using preoperative 3D CT reconstruction were not identified during the operalion,bul a white dense fibrous incisure wilhin the foolprinl area of femo- ral allachment was found on medial wall of lateral condyle femur and there was,no correlation between the residenl ridge and while dense fibrous notch（P〉0.O5）. Conclusion The incidence of lhe resident ridge has no correlation wilh gender bul a correlalion wilh age while it has a polenlial correlation with the conlinuous stress stimuli applied on the anterior limiting lamina of ACI, femoral attachmenl,which needs furiher study to confirm. Furlher studies are necessary for Ihe use of residenl ridge as marks for individualized osseous positioning of proximal and dislal femur in arthroscopie ACI, reconstruction. The white dense fihrous notch identified in Ihe operation of Group B and C, i.e. dense fibrous nolch of ACI, femoral footprint area,can be used as a reterence for individualized osseous posilioning of femoral tunnel in ACL reconstruction. ridge, femoral ACL foolprint, osseous landmark, while