双源CT三维重建前交叉韧带股骨止点及隧道面积的临床研究

目的通过双源CT（DSCT）三维重建前交叉韧带（ACL）股骨止点印迹及骨隧道面积，为临床实现解剖重建提供依据。方法分别对55例志愿者110膝，30例双束重建60膝及30例单束重建患者60膝进行DSCT扫描。64排工作站（GE，Volume Share 2-AW4．4软件）三维重建膝关节股骨外髁三维模型，再现股骨外髁内侧壁ACL印迹，圈画、测量印迹及骨隧道面积，计算单、双束骨道面积覆盖率。结果ACL股骨自然印迹面积双膝之间：左（146．35±29．0）mm2，右（144．51±33．71）mm^2，两者间无统计学差异（t=0．52，P〉0．05）。性别间自然印迹面积比较：AMB：男（87．08±19．29）mm。，女（77．09±15．17）mm^2，两者间有统计学差异（t=2．04，P〈0．05）；PLB：男（62．82±15．19）mm^2，女（61．64±16．55）mm^2，两者间无统计学差异（t=0．27，P〉0．05）。术后隧道面积覆盖率比较：单束（53±18）％，双束（70±16）％，两者间有统计学差异（t=2．44，P〈0．05）。结论ACL股骨止点自然印迹面积存在性别间及个体化差异，双束重建止点面积覆盖率显著大于单束重建，要实现ACL解剖重建需采用个体化重建技术。

Clinical study on three-dimensional reconstruction of tunnel area and femoral insertion footprint of anterior cruciate ligament by dual-source CT

Objective To reconstruct the femoral footprint of anterior cruciate ligament（ACL） and measure the areas of femoral tunnels with dual-source computed tomography （DSCT） and three-dimensional （3D）technique, in order to establish a theory basis for the anatomic ACL reconstruction. Methods 110 knees from 55 volunteers were scanned by 64-slice spiral CT workstation （ GE, Volume Share2-AW 4. 4 version） ; 30 double-bundle reconstructed knees and 30 single-bundle reconstructed knees were examined under the same parameters. Lateral wall of the intercondylar notch and the ACL femoral footprint were reconstructed three-dimensionally. The area of original footprint and femoral tunnels was calculated and compared with that of single- and double-bundle femoral tunnel coverage. P-value 〈 0.05 was defined as significant. Results The mean area of ACL femoral footprint was （146. 35±29.0） mm2 in the left knee and （144. 51±33.71 ）mmz in the right knee respectively. There was no significant difference between the left and right （t = 0. 52, P 〉 0. 05）. Area of anterior-medial bundle （AMB） of male （87. 08±19. 29） mm2 ] was larger than that of female （ 77. 09±15. 17 ） mm2 ] （ t = 2. 04, P 〈 0. 05 ）, while there was no significant difference between male （62. 82±15.19） mm^2 ] and female （61.64 ±16. 55 ） mm^2 ] in areas of posterior-lateral bundle （PLB） （ t = 0. 27, P 〉 0. 05 ）. The footprint coverage was （53 ＋ 18 ） % in single-bundle reconstruction and （70±0. 16） % in double-bundle reconstruction; the later was significant higher than the former （t = 2.44, P 〈 0. 05 ）. Conclusions The natural ACL femoral footprints differs from one another in shape, position and area according to our observation by 3-D imaging reconstruction. Double-bundle reconstruction of ACL has better coverage of femoral anatomic insertion than single-bundle reconstruction. Individualized reconstruction should be applied in anatomic reconstruction of ACL.