ACL重建股骨隧道长度与股骨髁解剖学参数相关性研究

Correlation between ACL reconstruction of femoral tunnel length and femoral condylar anatomy

目的应用三维重建结合Mimics图像分析系统,研究股骨远端解剖学参数与ACL重建术中股骨隧道长度的相关性。方法选取自2015-01—2018-02采用AMP单束解剖重建治疗ACL断裂患者31例,术中利用股骨隧道尺进行测量,术后第2天均利用患侧膝关节3D-CT和Mimics 19.0软件重建同侧股骨远端三维图像,测量髁间窝顶前后径、股骨外髁内壁高度和NWI参数,同时纳入年龄、身高、体重及性别自变量,分析影响股骨隧道长度的因素。结果身高、体重和髁间窝顶前后径是股骨隧道长度的独立影响因素,其偏回归系数B分别为0.12、0.08、0.42,标准化的偏回归系数(β)三者分别为0.34、0.29、0.36,三者之间的绝对值无明显差异,回归方程中确定系数与调整的R Square分别为0.84、0.83。结论股骨隧道的长度与股骨远端解剖学参数(股骨髁间窝前后出口最高点连线长度)、不同个体资料数据(身高、体重、性别)均具有相关性,术前依据不同个体的骨性解剖学、人口统计学参数进行股骨隧道长度的预测,可有效地降低术中制备股骨隧道过短的风险,最大限度地规避AMP解剖重建术中的缺陷。

Objective To study the correlation between distal femoral anatomical parameters and the length of femoral tunnel in ACL reconstruction by using the Mimics image analysis system with three-dimensional reconstruction.Methods From January 2015 to February 2018,31 patients with ACL rupture treated with the AMP single bundle anatomical reconstruction were selected.In operation the ruler was used to measure femoral tunnel.On the second day after operation,3 D-CT of the operated knee joint and Mimics19.0 software were used to reconstruct the 3 D images of the ipsilateral distal femur,to measure the anterior and posterior exit position vertex line diameter of the femoral intercondylar notch,the height of the lateral wall of the femoral intercondylar notch and the parameters of NWI.At the same time,age,height,weight and gender were included to analyze the factors affecting the length of the femoral tunnel.Results Height,weight and the anterior and posterior exit position vertex line diameter of the femoral intercondylar notch is Independent influence factor of the femoral tunnel length factors with partial regression coefficients B were 0.12,0.08,0.42,the standard partial regression coefficient(Beta)were 0.34,0.29,0.36,there was no significant difference in the absolute value,the regression equation coefficient and the adjusted R Square was 0.84,0.83,respectively.Conclusion The distal femoral anatomy parameters(anterior and posterior exit position vertex line diameter of the femoral intercondylar notch),different individual data(height,weight,gender)are correlated with femoral tunnel length in anatomical single bundle ACL reconstruction,depending on individual osseous anatomy,preoperative demographic parameters prediction of the femoral tunnel length,can effectively reduce the risk of intra-operative preparation of femoral tunnel are too short,of utmost avoid AMP anatomical revascularization of the defects.