两种前交叉韧带重建MRI测量移植物位置比较

Comparison of graft position measured by MRI between two anterior cruciate ligament reconstruction techniques

[目的]探讨磁共振成像(MRI)测量前内侧入路(anteromedial, AM)法和经胫骨隧道(transtibial, TT)法建立股骨隧道重建前交叉韧带(anterior cruciate ligament, ACL)移植物位置的差异。[方法]回顾性分析2017年1月-2018年12月本院收治的62例患者,其中32例采用AM法,30例采用TT法。行MRI检查,测量冠状面移植物股骨止点与12点位的夹角(α角)、矢状面移植物轴线与Blumensaat线夹角(β角)、矢状面股骨隧道后壁厚度(AB),以及矢状面移植物与胫骨平台面夹角(θ角)、矢状面胫骨止点位置(CE/CD)、冠状面移植物与胫骨平台面夹角(γ角)和冠状面胫骨止点位置(GF/GH)。[结果]股骨侧,两组在α角、β角和AB的差异均无统计学意义(P>0.05);末次检查时两组的α角、β角和AB与首次检查的差异均无统计学意义(P>0.05)。胫骨侧,AM组θ角显著小于TT组(P<0.05);但两组间在γ角、CE/CD和GF/GH的差异均无统计学意义(P>0.05);末次检查时两组的θ角均较首次检查显著减小(P<0.05),而γ角、CE/CD及GF/GH的差异无统计学意义(P>0.05)。[结论]本研究表明在矢状面上,TT法移植物较AM法更为垂直;随着术后时间延长,两种术式移植物的矢状面角度会减小。

[Objective] To explore the difference in graft position measured by magnetic resonance imaging(MRI) between the anteromedial(AM) and the transtibial(TT) techniques for establishment of the femoral tunnel in anterior cruciate ligament(ACL) reconstruction.[Methods] A retrospective study was conducted on 62 patients who received ACL reconstruction in our hospital from January 2017 to December 2018. Of them, 32 patients were treated by AM method, while the other 30 patients were by TT method. MRI was done to measure the angle between the graft femoral insertion and the 12 o’clock position in the coronal plane(α angle), the angle between graft axis and the Blumensaat line(β angle) and the thickness of the posterior femoral wall(AB) in the sagittal plane, as well as the angle between the graft axis and the tibial plateau(θ angle), the tibial insertion position(CE/CD) in the sagittal plane, the angle between the graft and the tibial plateau(γ angle) and the tibial insertion position(GF/GH) in the coronal plane. [Results] On the femoral side, there was no significant difference in α, β angle and AB between the two groups at the first examination(P>0.05). At the last examination, both groups showed no significant differences compared to those at the first examination(P>0.05). On the tibial side, the θ angle in the AM group was significantly smaller than that in the TT group at the first examination(P<0.05), but there was no significant difference in γ angle, CE/CD and GF/GH between the two groups(P>0.05). At the last examination, the θ angle of both groups decreased significantly compared to those at the first examination(P<0.05), while the differences of γ angle, CE/CD and GF/GH between two groups were not statistically significant(P>0.05).[Conclusion] This study shows that in the sagittal plane, the TT method get graft more vertical than the AM method, with the prolongation of postoperative time, this angle will decrease in both procedures.