容积CT三维重建评估膝关节前交叉韧带重建术骨隧道的价值

The value of volumetric CT three-dimensional reconstruction technique in evaluating bone tunnel after knee anterior cruciate ligament reconstruction

目的:应用容积CT三维重建评估前交叉韧带重建术后胫骨、股骨骨隧道位置及隧道角度对疗效的影响。方法:对行前交叉韧带重建术的91例患者术后行320排容积CT扫描并行三维重建。采用Lorenz法测量胫骨隧道中心点相对位置百分比(P_(t)),采用Bernard法测量股骨隧道中心点相对位置百分比(P_(f));用Wang和Segawa的方法测量胫骨隧道与胫骨干角度(α角)、胫骨隧道与关节线角度(β角)、股骨隧道与关节线角度(γ角)及股骨隧道与股骨干角度(θ角)。术后3个月采用国际膝关节文献委员会(IKDC)评分法对患者进行关节疗效评估,以评分90为界将患者分为两组进行统计学分析;绘制受试者工作特征曲线(ROC)分析各指标的诊断效能。结果:IKDC评分<90分和≥90分组间P_(t)差异无统计学意义(t=-1.197,P=0.234);P_(f)差异有统计学意义(t=-2.219,P=0.029),ROC曲线下面积为65.168%。胫骨隧道α角(t=0.038,P=0.970)和β角(t=0.908,P=0.366)差异无统计学意义;IKDC评分≥90分组股骨隧道γ角(t=3.228,P=0.002)和θ角(t=5.378,P<0.001)明显小于IKDC<90分组,ROC曲线下面积分别为73.136%和80.848%。结论:容积CT扫描三维重建对前交叉韧带骨隧道的位置及角度的判断准确,适当的股骨隧道位置和角度更有利于术后的恢复。

Objective:To evaluate the effect of tibiofibular and femoral tunnel locations and tunnel angle on the curative effect of anterior cruciate ligament(ACL)reconstruction using 320-row-volume CT.Methods:Ninety-one patients with ACL reconstruction participated in this study since January 2017 to June 2019.The following 3D reconstruction was performed by 320-row-volume CT.The relative position(P_(t))of the central point of the tibial tunnel was measured by the Lorenz method.Percentage of relative position of the center point of femoral tunnel(P_(f))was measured by Bernard method.α,β,γandθwere defined as angle of tunnel and tibial,tibial tunnel and joint line,femoral tunnel and joint line,tunnel and femoral respectively by Wang and Segawa methods.At 3 months postoperatively,the curative effect was evaluated by the International Knee Documentation Committee(IKDC)score and patients were grouped by the IKDC score(the group of IKDC<90 and the group of IKDC≥90).Diagnostic efficacy of each indicator was analyzed by receiver operating characteristic curve(ROC curve).Results:No significant difference of P_(t) values was observed between the two groups(t=-1.197,P=0.234).The P_(f) values in the group of IKDC≥90 were 65.158±0.074,which were significantly larger than the corresponding values of 60.965±0.069 in the IKDC<90 group(t=-2.219,P=0.029).The area under the ROC curve was 65.168%.No significant difference of theαangle(t=0.038,P=0.970)and theβangle(t=0.908,P=0.366)were found between the two groups.Theγangle(t=3.228,P=0.002)and theθangles(t=5.378,P<0.001)in the IKDC score≥90 group were significantly smaller than the which in the IKDC<90 group,and the area under the ROC curve was 73.136%and 80.848%,respectively.Conclusion:3D computed tomography can provide accurate judgments about the position and angle of the ACL reconstruction bone tunnel.And the suitable femoral tunnel locations and angles are more conducive to recovery.