基于3D-CT的前交叉韧带解剖重建及 功能性预后的临床研究

Clinical study on anatomic anterior cruciate ligament reconstruction and functional prognosis aided by three-dimensional CT reconstruction

摘要:

目的 观察基于3D-CT辅助的前交叉韧带（ACL）重建术股骨止点的解剖性和功能性预后。方法 2011年1月-2012年1月，完成采用3D-CT辅助下ACL自体肌腱移植重建术16例，平均（32±11）岁，平均病程（41.4±46.1）个月，平均随访时间（16.7±3.5）个月。术后用3D-CT观察患者股骨隧道位置，手术前、后采用Lysholm评分对膝关节功能进行评定。结果 术后3D-CT观察到股骨隧道位置良好，按照四格表测量方法，隧道中心与生理性AM和PL束连线中点接近。术前Lysholm评分总分为（66.9±6.4）分，手术后Lysholm评分总分提高至（83.5±5.3）分，手术前后Lysholm评分差异有显著性（t =8.25，P <0.001）。结论 3D-CT辅助可准确判定ACL重建手术的解剖性，指导医生实施解剖重建，有助于患者获得良好的功能性预后。

Abstract:

【Objective】 To observe the location of femoral tunnel and functional prognosis of anatomic anterior cruciate ligament (ACL) reconstruction aided by three-dimensional CT (3D-CT). 【Methods】 During the period between Jan. 2011 and Jan. 2012, 16 patients suffered from ACL rapture were treated by arthroscopic autograft ACL reconstruction aided by three-dimensional CT. The average age of the patients was (32±11) years. Patients suffered from knee problem average (41.4±46.1) months before operation. They were followed up post-operationally average (16.7±3.5) months. After operation, 3D-CT analysis of patients were performed to show the location of femoral insertion. The patients were assessed pre-operationally and post-operationally by the Lysholm score. 【Results】 Post-operational 3D-CT showed anatomic location of femoral insertion of ACL reconstruction, which was close to the midpoint between native AM and PL bundles of ACL. Lysholm score of patients showed a significant improvement from (66.9±6.4) pre-operation to (83.5±5.3) post-operation (t =8.25, P <0.001). 【Conclusion】 Application of 3D-CT can precisely identify the location of femoral insertion of ACL reconstruction, which is helpful for surgeon to perform anatomic reconstruction and for patients to obtain excellent prognosis.