CAJ | 학술논문

目的利用双源CT三维重建前交叉韧带(ACL)单束重建术后移植物,并评价移植物走形与骨隧道定位的关系.方法对2012年12月至2013年11月收治的76例(男33例,女43例;平均年龄为33.4岁)ACL单束重建术后患者膝关节进行双源CT三维重建.根据患者ACL移植物与骨隧道的位置分为3组:撞击组22例(ACL移植物与髁间窝存在撞击),偏后组21例(胫骨隧道位置偏后),满意组33例(胫骨隧道及ACL移植物位置满意).测量并比较3组患者股骨隧道中心点的相对位置百分比(Fx、Fy)和胫骨隧道中心点的相对位置百分比(Tx、Ty). 结果 76例患者均成功重建了隧道及移植物图像.撞击组患者的Fx、Fy平均分别为22.6％±1.2％、22.4％±1.1％,Tx、Ty平均分别为53.6％±2.0％、34.7％±1.7％;偏后组患者的Fx、Fy平均分别为22.4％±1.0％、23.7％±1.4％,Tx、Ty平均分别为56.8％±0.8％、50.9％±1.3％;满意组患者的Fx、Fy平均分别为21.7％±1.0％、23.3％±1.1％,Tx、Ty平均分别为55.4％±1.6％、43.0％±1.9％.3组患者的Fx、Fy比较差异均无统计学意义(P＞0.05).3组患者的Tx、Ty比较差异有统计学意义(P＜0.05),偏后组、满意组的Tx均高于撞击组,偏后组Ty＞满意组Ty＞撞击组Ty,以上组别之间比较差异均有统计学意义(P＜0.05). 结论双源CT能够清晰重建术后骨隧道及ACL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,从而指导术者改进手术.
목적 이용쌍원CT삼유중건전교차인대(ACL)단속중건술후이식물,병평개이식물주형여골수도정위적관계.방법 대2012년12월지2013년11월수치적76례(남33례,녀43례;평균년령위33.4세)ACL단속중건술후환자슬관절진행쌍원CT삼유중건.근거환자ACL이식물여골수도적위치분위3조:당격조22례(ACL이식물여과간와존재당격),편후조21례(경골수도위치편후),만의조33례(경골수도급ACL이식물위치만의).측량병비교3조환자고골수도중심점적상대위치백분비(Fx、Fy)화경골수도중심점적상대위치백분비(Tx、Ty). 결과 76례환자균성공중건료수도급이식물도상.당격조환자적Fx、Fy평균분별위22.6％±1.2％、22.4％±1.1％,Tx、Ty평균분별위53.6％±2.0％、34.7％±1.7％;편후조환자적Fx、Fy평균분별위22.4％±1.0％、23.7％±1.4％,Tx、Ty평균분별위56.8％±0.8％、50.9％±1.3％;만의조환자적Fx、Fy평균분별위21.7％±1.0％、23.3％±1.1％,Tx、Ty평균분별위55.4％±1.6％、43.0％±1.9％.3조환자적Fx、Fy비교차이균무통계학의의(P＞0.05).3조환자적Tx、Ty비교차이유통계학의의(P＜0.05),편후조、만의조적Tx균고우당격조,편후조Ty＞만의조Ty＞당격조Ty,이상조별지간비교차이균유통계학의의(P＜0.05). 결론 쌍원CT능구청석중건술후골수도급ACL이식물적도상,림상상가용우평고골수도정위여이식물주형적관계,종이지도술자개진수술.
Objective To evaluate the relationship between the graft and tunnel locations by three-dimensional reconstruction of the graft and tunnel after single-bundle reconstruction of the anterior cruciate ligament (ACL) using dual-source computed tomography (DSCT).Methods DSCT scanning of the knee joint was performed in the 76 patients who had undergone single-bundle ACL reconstruction from December 2012 to November 2013.They were 33 men and 43 women,with an average of 33.4 years.According to the graft and tunnel locations,they were divided into 3 groups.Group A had 22 patients who showed roof-graft impingement; group B had 21 patients who showed posterior deviation of the tibial tunnel; group C had 33 patients who exhibited satisfactory locations of the graft and tibial tunnel.Femoral tunnel position (Fx,Fy) and tibial tunnel position (Tx,Ty) were measured and compared among the 3 groups.Results Three-dimensional images of the graft and tunnel were successfully reconstructed.In group A,the average Fxl and Fyl were 22.6％ ± 1.2％ and 22.4％ ± 1.1％ respectively while the Txl and Tyl were 53.6％ ±2.0％ and 34.7％ ± 1.7％ respectively.In group B,Fx2 and Fy2 were 22.4％ ± 1.0％ and 23.7％ ± 1.4％ respectively while the Tx2 and Ty2 were 56.8％ ± 0.8％ and 50.9％ ± 1.3％ respectively.In group C,the Fx3 and Fy3 were 21.7％ ± 1.0％ and 23.3％ ± 1.1％ respectively while the Tx3and Ty3 were 55.4％ ± 1.6％ and 43.0％ ± 1.9％ respectively.There was no significant difference between any groups in the femoral tunnel position (P ＞ 0.05),but significant differences were found in the tibial tunnel position between the 3 groups (P ＜ 0.05).Tx2 and Tx3 were significantly higher than Tx1 (P ＜ 0.05),and a significant difference was observed between Ty2 ＞ Ty3 ＞ Ty1 (P ＜ 0.05).Conclusion Since three-dimensional reconstruction images based on DSCT can clearly display the graft and tunnel,they can be used in clinic to evaluate the relationship between the graft and tunnel locations,helping surgeons improve their surgical outcomes.