术前MRI测量腘绳肌肌腱横截面积预测前交叉韧带重建术中移植物直径的初步研究

Preliminary study of preoperative MRI measurement of hamstring tendon cross-sectional area to predict graft diameter during anterior cruciate ligament reconstruction

目的探讨术前MRI测量的腘绳肌(半腱肌+股薄肌)肌腱横截面积预测前交叉韧带重建(ACLR)术中移植物直径的价值。方法回顾性收集2013年1月至2020年8月在南方医科大学第三附属医院进行4股腘绳肌肌腱单束ACLR患者的术前膝关节MRI图像, 共265例。根据术中移植物直径将患者分为移植物直径≥8 mm组(129例)和移植物直径<8 mm组(136例)。在术前MRI横断面图像股骨内外髁最大层面测量半腱肌和股薄肌肌腱的横截面积, 将两者相加获得腘绳肌肌腱横截面积。使用独立样本t检验比较移植物≥8 mm组与移植物<8 mm组间各肌腱横截面积的差异, 采用Spearman相关分析评估肌腱横截面积与术中移植物直径的相关性, 使用多因素logistic回归分析筛选肌腱横截面积中对术中移植物直径的影响因素, 绘制受试者操作特征曲线评估其预测术中移植物直径≥8 mm的效能。结果术中测量移植物直径为7.5(7.5, 8.0)mm。移植物直径≥8 mm组腘绳肌肌腱横截面积为(21.4±4.6)mm^(2), 移植物直径<8 mm组腘绳肌肌腱横截面积为(15.6±3.7)mm^(2)。移植物直径≥8 mm组和移植物直径<8 mm组间半腱肌、股薄肌、腘绳肌肌腱横截面积差异均有统计学意义(t=-10.26、-10.29、-11.47, P<0.001)。术中移植物直径与半腱肌、股薄肌、腘绳肌横截面积呈正相关, 相关系数分别为0.57(P<0.001)、0.58(P<0.001)、0.62(P<0.001)。多因素logistic回归结果显示腘绳肌肌腱横截面积是预测术中移植物直径的影响因素(OR=1.45, 95%CI 1.32~1.59, P<0.001)。腘绳肌肌腱横截面积预测术中移植物直径≥8 mm的曲线下面积为0.838(95%CI 0.792~0.885), 临界值为20.0 mm^(2), 灵敏度为0.581, 特异度为0.941。结论术前MRI测量腘绳肌肌腱横截面积可用于预测自体腘绳肌移植物直径大小。

Objective To investigate the value of preoperative MRI measurements of hamstring(semitendinosus+gracilis)tendon cross-sectional area in predicting intraoperative graft diameter for anterior cruciate ligament reconstruction(ACLR).Methods A total of 265 preoperative MRI were retrospectively collected in the Third Affiliated Hospital of Southern Medical University from January 2013 to August 2020 for patients who underwent single-bundle ACLR of hamstring tendon.Patients were divided into a graft diameter≥8 mm group(129 patients)and a graft diameter<8 mm group(136 patients)according to intraoperative graft diameter.The cross-sectional areas of the semitendinosus and gracilis tendons were measured at the largest level of the femoral condyle on preoperative MRI cross-sectional images,and the two were summed to obtain the cross-sectional area of the hamstring tendon.The independent samples t-test was used to compare the differences in the cross-sectional area of each tendon between the graft diameter≥8 mm group and the graft diameter<8 mm group.The Spearman correlation analysis was used to assess the correlation between tendon cross-sectional area and intraoperative graft diameter.Multi-factor logistic regression analysis was used to screen the influence of tendon cross-sectional area on intraoperative graft diameter.The effectiveness of intraoperative graft diameter≥8 mm was assessed by plotting the receiver operating characteristic curves.Results Intraoperative measurement of graft diameter was 7.5(7.5,8.0)mm.The cross-sectional area of the popliteal tendon was(21.4±4.6)mm^(2) in the graft diameter≥8 mm group and(15.6±3.7)mm^(2) in the graft diameter<8 mm group.Statistically significant differences were found in the cross-sectional areas of the semitendinosus,soleus and hamstring tendons between the graft diameter≥8 mm group and graft diameter<8 mm group(t=-10.26,-10.29,-11.47,P<0.001).Intraoperative graft diameter was positively correlated with the cross-sectional area of the semitendinosus,gracilis,and hamstring,with correlation coefficients of 0.57(P<0.001),0.58(P<0.001),and 0.62(P<0.001),respectively.Multi-factor logistic regression showed that popliteal tendon cross-sectional area was a predictor of intraoperative graft diameter(OR=1.45,95%CI 1.32-1.59,P<0.001).The area under the curve for popliteal tendon cross-sectional area to predict intraoperative graft diameter≥8 mm was 0.838(95%CI 0.792-0.885),with a critical value of 20.0 mm^(2),a sensitivity of 0.581,and a specificity of 0.941.Conclusion The measurement of the cross-sectional area of the hamstring muscle on preoperative MRI can predict the diameter of the autologous hamstring graft of ACLR.