膝关节解剖形态与前交叉韧带损伤位置的相关性研究

Correlation Between the Anatomical Morphology of Knee Joint and the Location of Anterior Cruciate Ligament Injury

目的探讨MRI测量外侧胫骨平台后倾角(lateral tibial plateau slope,LPS)、股骨髁间窝宽度指数(notch width index,NWI)与前交叉韧带(anterior cruciate ligament,ACL)损伤部位的相关性。方法回顾性分析我科自2018年9月至2020年9月收治的ACL完整患者40例及ACL损伤患者80例,共120例。其中男45例,女75例;年龄16~52岁,平均(30.08±9.95)岁。在患者行膝关节镜手术时明确并记录ACL损伤的部位,根据是否损伤及损伤部位分为三组,每组40例。非近端组:ACL损伤部位远离股骨端;近端组:ACL损伤部位靠近股骨端;对照组:膝关节镜下ACL完整的患者。观察LPS及NWI与ACL损伤部位的关系。结果(1)非近端组、近端组及对照组中LPS分别为(8.20±4.37)°、(6.34±3.33)°和(4.52±2.27)°,三组之间差异有统计学意义(P<0.05),且ACL损伤患者的LPS均高于ACL完整组,三组间LPS两两比较差异均有统计学意义(P<0.05);(2)非近端组、近端组及对照组中NWI分别为(0.26±0.41)、(0.30±0.28)和(0.33±0.44),三组之间差异有统计学意义(P<0.05),且ACL损伤患者的NWI均低于ACL完整组,三组间NWI两两比较差异均有统计学意义(P<0.05)。结论膝关节外侧胫骨平台后倾角及髁间窝指数均是导致ACL不同损伤部位的重要解剖因素,且LPS较大和NWI较小的患者更容易损伤ACL远端部位。

Objective To explore the correlation between MRI measurement of lateral tibial plateau slope(LPS),notch width index(NWI)and anterior cruciate ligament(ACL)injury site.Methods A retrospective analysis was made of 40 cases without ACL injury and 80 cases of ACL injury diagnosed in our department from September 2018 to September 2020,including 45 males and 75 females.The average age was(30.08±9.95)years.The site of ACL injury was determined and recorded during knee arthroscopic surgery,and the patients were divided into three groups according to the site of injury,with 40 patients in each group.In the non-proximal group the ACL injury sites were far away from the femoral end.In the proximal group,ACL injury site were near the femur end.And in the control group,patients had intact ACL under knee arthroscopy.The relationship between LPS,NWI and ACL injury site was observed.Results(1)LPS in the non-proximal group,proximal group and control group were(8.20±4.37)°,(6.34±3.33)°and(4.52±2.27)°,respectively,and the differences among the three groups were statistically significant(P<0.05).LPS in patients with ACL injury were higher than those in the intact ACL group.Pairwise comparison of LPS among the three groups had statistical significance(P<0.05).(2)NWI in the non-proximal group,proximal group and control group were(0.26±0.41),(0.30±0.28)and(0.33±0.44),respectively,and the differences among the three groups were statistically significant(P<0.05).NWI in patients with ACL injury was lower than that in the intact ACL group.There were statistically significant differences in NWI among the three groups(P<0.05).Conclusion Both posterior dip Angle of tibial plateau and intercondylar fossa index are important anatomical factors leading to different injury sites of ACL,and patients with larger LPS and smaller NWI are more likely to injure the distal part of ACL.