前交叉韧带断裂合并半月板撕裂的解剖学影响因素分析

Analysis of anatomic factors influencing anterior cruciate ligament rupture combined with meniscus tears

目的:分析前交叉韧带(anterior cruciate ligament,ACL)断裂合并半月板撕裂的解剖学影响因素。方法:纳入ACL断裂患者141例,从病历系统中提取患者的性别、年龄、损伤侧别、体质量指数、是否合并半月板撕裂等信息。在影像归档和通信系统中提取患者MRI,测量股骨髁间窝宽度指数、α角、β角、胫骨外侧平台后倾角和胫骨内侧平台后倾角等解剖学参数。根据半月板是否撕裂将纳入的患者分为合并半月板撕裂组和不合并半月板撕裂组。先对2组患者的相关信息进行单因素对比分析,然后对其中组间差异有统计学意义的因素进行多因素Logistic回归分析。采用受试者操作特征(receiver operating characteristic,ROC)曲线分析评价解剖学影响因素诊断ACL断裂合并半月板撕裂的价值。结果:合并半月板撕裂组76例,不合并半月板撕裂组65例。2组患者性别、股骨髁间窝宽度指数、α角、β角、胫骨内侧平台后倾角、胫骨外侧平台后倾角的比较,组间差异均有统计学意义(χ^(2)=5.248,P=0.022;0.247±0.032,0.273±0.024,t=5.501,P=0.000;46.70°±7.04°,50.73°±7.76°,t=3.207,P=0.000;41.48°±2.22°,38.30°±3.16°,t=6.805,P=0.000;6.85°±2.59°,5.61°±1.76°,t=3.363,P=0.000;8.04°±3.32°,5.34°±1.83°,t=6.690,P=0.000)。Logistic回归分析结果显示,股骨髁间窝宽度指数、β角、胫骨外侧平台后倾角是ACL断裂合并半月板撕裂的影响因素(β=-1.118,P=0.000,OR=3.060;β=0.530,P=0.000,OR=3.985;β=1.372,P=0.000,OR=3.944)。ROC曲线分析结果显示,股骨髁间窝宽度指数、β角、胫骨外侧平台后倾角诊断ACL断裂合并半月板撕裂的临界值分别为0.250、38°、8°,敏感度分别为83.2%、88.8%、56.6%,特异度分别为60.8%、56.8%、88.6%,ROC曲线下面积分别为0.683(P=0.001)、0.647(P=0.006)、0.651(P=0.005)。结论:股骨髁间窝宽度指数、β角、胫骨外侧平台后倾角是ACL断裂合并半月板撕裂的解剖学影响因素,应用股骨髁间窝宽度指数、β角、胫骨外侧平台后倾角诊断ACL断裂合并半月板撕裂具有一定的价值。

Objective:To analyze the anatomic factors influencing anterior cruciate ligament(ACL)rupture combined with meniscus tears(MTs).Methods:One hundred and forty-one patients with ACL rupture were enrolled in the study.The information about gender,age,injuried side,body mass index,whether combined with MTs was extracted from the electronic medical record system(EMRS).Moreover,the magnetic resonance imaging(MRI)of the included patients were extracted from the picture archiving and communication system(PACS),and the anatomical perameters including femoral itercondylar fossa(ICF)width index,angle a,angle β,lateral posterior tibial slope(PTS)and medial PTS wene measured on the MRI images.The included patients were divided into MTs group and non-MTs group according to whether the MTs were present.The single-fauctor comparative analysis was performed on the relevant information of patients in the 2 groups,followed by multi factor logistic regression analysis on the factors with statistically signific ant differencs between the 2 groups.F urthermore,the values of anatomic factors in diagnosing ACL rupture combined with MTs were analyzed and evalusted by using receiver operating characteristic(ROC)curve.Results:One hundred and forty-one patients with ACL rupture were included in the final analysis,76 cases in MTs group and 65 cases in non-MTs group.The information including gender,femoral ICF width index,angle a,angleβ,medial PTS and lateral PTS was compared between the 2 groups,and the results revealed that the diferences were stistically significant(χ^(2)=5.248,P=0.022;0.247±0.032,0.273±0.024,t=5.501,P=0.000;46.70°±7.04°,50.73°±7.76°,t=3.207,P=0.000;41.48°±2.22°,38.30°±3.16°,t=6.805,P=0.000;6.85°±2.59°,5.61°±1.76°,t=3.363,P=0.000;8.04°±3.32°,5.34°±1.83°,t=6.690,P=0.000).The results of logistic regression analysis showed that the femoral ICF width index,angleβand lateral PIS were the anatonic factors influencing ACL rupture combined with MTs(β=-1.118,P=0.00,0R=3.060;β=0.530,P=0.000,0R=3.985;β=1.372,P=0.000,0R=3.944).The results of ROC curve analysis showed that the diagnostic cut-of values of fermoral ICF width index,angleβand lateral PTS in diagnosing ACL rupture combined with MTs were 0.250,38 degree and 8 degree;the sensitivity were 83.2%,88.8%and 56.6%;the specificities were 60.8%,56.8%and 88.6%;the areas under ROC curve were 0.683(P=0.001),0.647(P=0.006)and 0.651(P=0.005)espetiely.Conclusion:The fenoral ICF width index,angleβand lateral PTS are the anatomic factors influencing ACL rupture combined with MTs,and they have a certain application values in diagnosis of ACL rupture com-bined with MTs.