背景：有研究表明影响前交叉韧带重建手术效果的因素主要取决于骨道的位置，而目前对骨道位置的研究仍存在一定争议。目的：探讨3D-CT对关节镜辅助下前交叉韧带重建后骨道评估的临床价值。方法：对2014年1月至8月收治的58例前交叉韧带损伤患者行关节镜下前交叉韧带重建。股骨端采用Endobutton固定，胫骨端使用可吸收界面钉固定。分别对58个膝关节进行双源CT扫描，使用CT图像后处理工作站重建膝关节三维模型，再现股骨外髁内侧壁及重建后单束骨道，胫骨平台及骨道。根据Lysholm评分分级办法，将随访时Lysholm评分≥80分病例作为优良组，80分以下为不良组，标记、测量股骨及胫骨骨道中心点的相对位置，比较两者的位置关系。结果与结论：3D-CT 三维重建法清晰地反映了膝关节前交叉韧带重建后的骨道及其出入口的位置、固定物及移植物等情况。膝关节功能优良组与不良组患者的术侧膝关节的股骨骨道中心位置之间差异有显著性意义(P <0.05)，胫骨骨道中心位置之间差异无显著性意义(P >0.05)。结果证实，3D-CT能够清晰重建骨隧道及前交叉韧带移植物的图像，临床上可用于评估骨隧道定位与移植物走形的关系。%BACKGROUND:Studies have shown that factors affecting the outcomes of anterior cruciate ligament reconstruction mainly depend on the position of bone tunnels. However, there stil exists certain controversy over the researches on the position of bone tunnels. OBJECTIVE:To investigate the clinical value of three-dimensional computed tomography on postoperative evaluation of bone tunnel after anterior cruciate ligament reconstruction under arthroscopic assistance. METHODS:Fifty-eight patients with anterior cruciate ligament injury who received the treatment from January 2014 to August 2014 underwent anterior cruciate ligament reconstruction under arthroscopic assistance. The femoral end was fixed using an Endobutton, and tibial end was fixed using absorbable interference screws. 58 knees from patients were scanned respectively by means of a dual-source CT scanner. A three-dimensional model of knee was rebuilt on a CT image post-processing workstation to reproduce the medial wal of the lateral femoral condyle and reconstruct single-bundle anterior cruciate ligament, tibial plateau and bone tunnel. The cases that had a Lysholm score≥ 80 points were included in the excelent and good group and those who had a Lysholm score < 80 points in the poor group. The relative position of the center point of the femoral and tibial bone tunnels were marked and measured and the position relation between the two center points was estimated. RESULTS AND CONCLUSION: Three-dimensional computed tomography reconstruction method clearly reflected the situation of bone tunnel and its entrance, fixtures and grafts after anterior cruciate ligament reconstruction. There was significant difference in the center point of femoral tunnel of the knee on the operated side between excelent and good group and poor group (P < 0.05). There was significant difference in the center point of the tibial tunnel between these two groups (P > 0.05). These results confirm that three-dimensional computed tomography can help to clearly reconstruct the images of bone tunnel and anterior cruciate ligament grafts after operation, which can be used clinicaly to assess the relationship between bone tunnel location and graft misshaping.
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