中国组织工程研究

中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (18): 2881-2886.doi: 10.3969/j.issn.2095-4344.3832

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

三维重建CT与X射线片评价单束前交叉韧带类等长重建后骨隧道及移植物状态的比较

郑维蓬1，魏合伟1，刘治军1，万  雷1，陈  胜1，廖志浩1，胡伟坚2   

  1. 1广州中医药大学第三附属医院，广东省广州市   510375；2广州中医药大学，广东省广州市   510006
  • 收稿日期:2020-04-28 修回日期:2020-05-07 接受日期:2020-08-11 出版日期:2021-06-28 发布日期:2021-01-12
  • 通讯作者: 刘治军，主治医师，广州中医药大学第三附属医院，广东省广州市 510375
  • 作者简介:郑维蓬，男，1986年生，广东省揭阳市人，汉族，硕士，主治医师，主要从事骨关节运动损伤疾病方面的研究。
  • 基金资助:
    广东省中医药科研项目(20170283)，项目负责人：刘治军；广州中医药大学第三附属医院创新基金项目(sy2015001)，项目负责人：郑维蓬

Application of three-dimensional reconstructive CT versus X-ray in postoperative evaluation of bone tunnel and graft status after single bundle anterior cruciate ligament near-isometric reconstruction

Zheng Weipeng1, Wei Hewei1, Liu Zhijun1, Wan Lei1, Chen Sheng1, Liao Zhihao1, Hu Weijian2   

  1. 1Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510375, Guangdong Province, China; 2Guangzhou University of Chinese Medicine, Guangzhou  510006, Guangdong Province, China
  • Received:2020-04-28 Revised:2020-05-07 Accepted:2020-08-11 Online:2021-06-28 Published:2021-01-12
  • Contact: Liu Zhijun, Attending physician, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510375, Guangdong Province, China
  • About author:Zheng Weipeng, Master, Attending physician, Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510375, Guangdong Province, China
  • Supported by:
    the Scientific Research Project of Traditional Chinese Medicine in Guangdong Province, No. 20170283 (to LZJ); the Innovation Fund Project of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, No. sy2015001 (to ZWP)

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摘要：

文题释义：
前交叉韧带类等长重建：要求股-胫骨隧道内口之间的距离在膝关节屈伸过程中相对不变，从而避免或减少移植物与骨道间的滑动，促进腱-骨愈合。许多学者寻找最理想的前交叉韧带等长重建点，但由于膝关节在屈伸活动中前交叉韧带的张力及长度并非不变，因此实际并不存在绝对等长的位点区域。目前研究认为股骨端的类等长点位于过顶点前远方，此点兼顾了等长点和解剖点的优点，有利于恢复膝关节的稳定性及运动功能，并可实现移植物相对等长重建，即类等长重建。
三维重建CT(3D-CT)：经计算机软件系统处理，在X、Y轴的二维的连续断层图像上对Z轴进行投影转换及图像处理，重建为直观、精确的立体图像，并经过旋转处理和电子“解剖”，可以从各个方向观察组织结构的影像，从而了解到各组织解剖结构与空间的关系，这是图像处理技术的一大飞跃。

背景：目前对前交叉韧带重建后的影像学评价大多采用二维的X射线片，存在不立体、测量误差大等缺点，而三维重建CT对术后评价具有较高的准确性。
目的：探讨三维重建CT(3D-CT)与X射线片测量单束前交叉韧带类等长重建术后骨隧道的准确性及移植物状况。
方法：纳入2016 年1月至2019年12月广州中医药大学第三附属医院收治的关节镜下重建前交叉韧带患者31例，其中男28例，女3例，年龄20-47岁，均采用经前内侧入路定位股骨骨隧道，行单束类等长重建前交叉韧带。术后1周内分别给予3D-CT及X射线片检查，观察移植物及骨隧道的情况，采用Klos方法和Bernard方法分别测量胫骨、股骨的骨隧道位置。试验获得广州中医药大学第三附属医院伦理委员会批准。
结果与结论：①3D-CT三维容积成像影像能够清晰显示前交叉韧带重建后骨隧道情况，31例患者骨隧道壁均完整，股骨端移植物填充(21.71±2.16) mm，胫骨端移植物填充(14.23±1.78) mm(不计挤压螺钉部分)，还可观察重建后内固定物及移植韧带；②X射线片测量显示，31例患者胫骨矢状面、冠状面骨隧道内口位置分别为(44.17±5.23)%，(43.05±4.58)%，Blumensaat线水平股骨骨隧道内口位置为(28.75±4.59)%，距离髁间窝顶高度为(38.23±8.71)%；3D-CT测量显示，胫骨矢状面、冠状面骨隧道内口位置分别为(42.41±6.93)%，(43.66%±4.12)%，Blumensaat线水平股骨骨隧道内口位置为(32.41±6.33)%，距离髁间窝顶高度为(41.53±6.51)%；两种检测方法中仅Blumensaat线水平股骨骨隧道内口位置比较差异有显著性意义(P=0.011)；③结果表明，3D-CT与X射线片评价前交叉韧带类等长重建术后骨隧道位置的测量结果存在一定的差异，3D-CT测量可较客观、准确地反映骨隧道情况及移植物状态。
https://orcid.org/0000-0001-7257-4482 (郑维蓬) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 骨, 移植物, 前交叉韧带, 重建, 骨隧道, 3D-CT, X射线片

Abstract: BACKGROUND: The imaging evaluation of anterior cruciate ligament reconstruction mostly through two-dimensional X-ray has disadvantages of non-solid and large measurement error, while three-dimensional reconstructive CT (3D-CT) has higher accuracy for postoperative evaluation.
OBJECTIVE: To evaluate the accuracy of bone tunnel position and graft status after anterior cruciate ligament near-isometric reconstruction measured by 3D-CT and X-ray. 
METHODS: From January 2016 to December 2019, 31 patients with arthroscopic anterior cruciate ligament reconstruction were selected from the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, including 28 males and 3 females, at the age of 20-47 years. All patients were subjected to anterior medial approach to locate the bone tunnel of femur and anterior cruciate ligament near-isometric reconstruction. 3D-CT and X-ray examination were performed within one week after the operation to observe the condition of graft and bone tunnel. The position of bone tunnel in tibia and femur was measured by Klos method and Bernard method respectively. The trial was approved by the Ethics Committee of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine.
RESULTS AND CONCLUSION: (1) 3D-CT clearly showed the bone tunnel after anterior cruciate ligament reconstruction. The 31 patients had complete bone tunnel wall, (21.71±2.16) mm for femoral end graft and (14.23±1.78) mm for tibial end graft (excluding extrusion screw part). The internal fixator and graft ligament could also be observed. (2) X-ray films showed that the position of tibial tunnel was (44.17±5.23)% in sagittal plane and (43.05±4.58)% in coronal plane. The position of femoral tunnel was (28.75±4.59)% in Blumensaat line level and (38.23±8.71)% in height from the top of intercondylar fossa. 3D-CT showed that the position of tibial tunnel was (42.41±6.93)% in sagittal plane and (43.66%±4.12)% in coronal plane; the position of femoral tunnel was (32.41±6.33)% in blumensaat line level and (41.53±6.51)% in height from the top of intercondylar fossa. There was significant difference in tunnel position between the two methods at Blumensaat line level (P=0.011). (3) The results show that there are some differences between 3D-CT and X-ray films in the evaluation of bone tunnel position after anterior cruciate ligament near-isometric reconstruction. 3D-CT measurement can objectively and accurately reflect the condition of bone tunnel and graft state. 

Key words: bone, graft, anterior cruciate ligament, reconstruction, bone tunnel, 3D-CT, X-ray film

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