胫骨平台后倾角的测量及其对前交叉韧带损伤及重建影响的研究进展

Research progress on the measurement of posterior tibial slope and its effect on anterior cruciate ligament injury and reconstruction

目的探讨胫骨平台后倾角(PTS)的影像学测量方法及PTS大小对前交叉韧带(ACL)损伤及重建效果的影响研究进展。方法在中国知网、万方数据、PubMed等数据库,分别以“胫骨平台后倾角”“测量”“前交叉韧带”“损伤”“重建”以及“posterior tibial slope”“measure”“anterior cruciate ligament”“injure”“reconstruction”为中、英文关键词,检索2000年1月—2022年12月发表的与PTS测量方法、在ACL损伤及重建中的影响作的相关文献,共检索到574篇,剔除内容不符、质量较低、重复研究、证据等级不高、无法获取全文者,最终纳入47篇文献。总结PTS的测量方法,探讨PTS在ACL损伤及重建中的影响及其机制。结果目前PTS的影像测量可在X线片、CT及MRI上进行。其中X线片测量是最简单且应用最广的测量方法,但其测量值受参考标志及所选胫骨轴线长短影响;CT和MRI测量能够有效消除胫骨旋转的影响,测量值更准确,但技术难度及成本较高。PTS过大使得运动过程中膝关节过度内旋,加速ACL变性的进程,进而导致ACL损伤。ACL重建术后,PTS过大将导致膝关节前半脱位和移植物顶部撞击等情况发生,影响手术效果。结论目前PTS测量方法及正常范围值尚未统一。PTS过大将导致ACL损伤并影响ACL重建手术的临床效果。因此,术前选择合适的测量方法评估PTS对于手术方式的选择是必要的。

Objective This study aims to investigate the measurement of posterior tibial slope(PTS)and its research progress on anterior cruciate ligament(ACL)injury and reconstruction Methods Recent literature related to PTS in ACL injury published from January 2000 to December 2022 were searched in the database of CNKI,Wanfang data,and PubMed.The following keywords were used:"胫骨平台后倾角,""测量,""前交叉韧带,""损伤,"and"重建"as well as"posterior tibial slope,""measure,""anterior cruciate ligament,""injure,"and"reconstruction".A total of 574 were obtained,and 47 were finally included in the analysis after excluding those that were inconsistent to the subject,had incomplete text and low quality and level of evidence,and were replicates.The measurement methods of PTS were summarized,and the effect and mechanism of PTS in ACL injury and reconstruction were explored.Results PTS was measured by X-ray,CT,and MRI.X-ray measurement is the simplest and most widely used method,but its measured value is affected by the reference mark and the length of the selected tibial axis.CT and MRI measurements can effectively eliminate the influence of tibial rotation,and the measured value is more accurate;however,their technical difficulty and costs are high.PTS is an anatomic factor in ACL injury.Excessive levels of PTS will cause excessive internal rotation of the knee during movement,thereby accelerating the occurrence of ACL strain and leading to ACL injury.In ACL reconstruction,excessive PTS will affect the surgical effect by inducing the anterior tibial subluxation of the knee joint after reconstruction and influencing graft roof impingement.Conclusion At present,the measurement method of PTS and its standard value have not been standardized.Excessive PTS will lead to the injury of ACL and affect the clinical outcomes of ACL reconstruction.For patients with ACL injury,a suitable method should be selected to measure PTS before conducting appropriate surgery.