前十字韧带移植重建后移植物撞击新类型

摘要

目的 通过双源CT三维重建前十字韧带(anterior cruciate ligament,ACL)移植重建后的移植物和骨隧道,分析移植物撞击症.方法 2012年11月至2014年11月,采用双源CT对134例ACL移植重建后患者的膝关节进行扫描,三维重建股骨和胫骨隧道、ACL重建移植物等.其中单束重建118例,男83例,女35例;年龄15～64岁,平均32岁.观察重建术后移植物是否受到撞击、撞击来源并进行分类;分别测量股骨、胫骨隧道的相对位置,并对有撞击与无撞击组患者进行统计比较.结果 基于双源CT移植物重建,根据ACL移植重建后移植物是否受到撞击分组,无撞击组39例(33％,39/118),有撞击组79例(67％,79/118).存在撞击者再根据撞击部位分为髁间窝出口撞击组77例(占总数的65％,占撞击组的97％)和髁间窝顶中途撞击组2例(占总数的2％,占撞击组的3％).进一步根据撞击来源不同,再对髁间窝出口撞击组分为3个亚型,即鸟喙撞击10例(3％,10/77)、胫骨平台撞击46例(60％,46/77)、钳夹撞击21例(27％,21/77).单因素方差分析显示,鸟喙撞击、胫骨平台撞击、钳夹撞击各组与无撞击组的股骨、胫骨隧道位置均无显著性差异.结论 基于双源CT三维重建ACL术后移植物扫描发现3种新的移植物撞击类型,即髁间窝顶中途撞击、胫骨撞击和钳夹撞击.%Objective To analyse the graft impingement after anterior cruciate ligament (ACL) reconstruction based on three-dimensional graft and tunnel images of dual-source computer tomography (DSCT).Methods From November 2012 to November 2014,a consecutive 134 cases of ACL reconstruction with various techniques had their knees scanned by DSCT.Graft and femoral as well as tibial tunnel images were three-dimensionally reconstructed and carefully inspected if there was any impinging on the graft at knee extension,meanwhile the femoral and tibial tunnel location were measured.Of these 134 cases,a serial of 118 patients had been single-bundle reconstructed with same type of graft material.There were 83 males and 35 females aged from 15 to 64 years old (mean,32 years old).Special attention had been paid to examine if there was any graft impinging,and their origin and finally impingement types were identified and classified according to the position and origin of impingement.Bernard and Lorenz method were used to measure the relative locations of femoral and tibial tunnel respectively.Difference was statistically compared between impingement-free and impingement groups.Results Patients were divided into two groups,impingement-free group and impingement group according to graft impinging based on graft visible 3D-CT imaging postoperatively.Of 118 cases,39 (33％) were impingement-free and 79 (67％) existed various types of impingement.Impingement group was further divided into two subgroups according to different impingement location,outlet impingement of intercondylar notch group (77 cases,account for 65％ of total and 97％ of impingement group,respectively) and mid-way impingement of intercondylar notch group (2 cases,account for 2％ of total and 3％ of impingement group,respectively).The outlet impingement group was more further classified into three subtypes,bird beak impingement,10 cases (13％,10/77),tibial plateau impingement,46 cases (60％,46/77) and clamp impingement,21 cases (27％,21/77).Statistic analysis with NAONA revealed that no significant difference between impingement group and impingement-free group regardless of femoral or tibial tunnel placement.Conclusion Three new types of impingements are found based on visible 3D-CT graft imaging after ACL reconstruction which are mid-way impingement of intercondylar notch,tibial plateau impingement and clamp impingement.