双源CT三维重建评价前交叉韧带骨道位置的临床研究

目的 探讨双源CT三维重建前交叉韧带（ACL）股骨止点自然印迹与骨道中心点相对位置关系.方法 分别对55例志愿者110个膝关节和30例双束重建患者30个患膝关节进行双源CT扫描.使用CT图像后处理工作站行三维重建膝关节股骨外髁内侧壁三维模型,再现股骨外髁内侧壁ACL自然印迹及术后双束骨道,标记、测量自然印迹及骨道中心点相对位置,比较两者的位置关系,显著性差异设定P值0.05.结果 ACL自然印迹中心点相对位置与术后双束骨道中心点相对位置比较：前内束,h对=（26.2±2.2）%,h实=（23.6±8.5）%,中心点相对位置比较有统计学差异（t=4.906,P〈0.01）;t对=（25.0±2.1）%,t实=（25.2±3.9）%,中心点相对位置比较无统计学差异（t=0.480,P〉0.05）.后外束,h对=（46.5±3.2）%,h实=（45.0±4.6）%,中心点相对位置比较无统计学差异（t=0.608,P〉0.05）;t对=（34.2±2.5）%,t实=（37.9±4.2）%,中心点相对位置比较无统计学差异（t=0.530,P〉0.05）.结论 （1） DSCT三维重建可清晰重建出ACL股骨止点自然印迹和双束重建术后骨道位置;（2） DSCT 三维重建可用于ACL解剖双束重建术后骨道位置评估,对改进关节镜下ACL解剖双束重建有指导意义.

Clinical research on femoral tunnels for anterior cruciate ligament reconstruction by dual-source CT three-dimensional reconstruction

Objective To compare the natural footpoints centers and the femoral tunnel apertures centers by dual-source computed tomography （DSCT） three-dimensional（3-D） reconstruction. Methods DSCT scans were performed on 55 pairs of knees （ 110 knees） and 30 double-bundle reconstructed knees after the arthroscopic double-bundle reconstruction of ACL. The 3-D reconstruction of the lateral wall of the intercondylar notch was done with 64-slice spiral CT workstation （ GE, Volume Share2-AW 4.4 version）. The double-bundle footprints of the ACL femoral insertions and the double-bundle femoral tunnels were identified. The centers of ACL natural footprints and the femoral double-bundle tunnels were marked; the relative locations were compared. P 〈 0. 05 was considered significant. Results The comparison of the relative locations of ACL natural footprints centers and the double-bundle tunnels： （ 1 ） Anteromedial bundle （AMB） ： hC = （ 26. 2 ± 2. 2 ） %, hE = （ 23.6 ± 8.5 ） % , there was significant difference （ t = 4. 906, P 〈 0. 01 ） ; tC = （25.0 ± 2. 1 ） %, tE = （25.2 ± 3.9） %, there was no significant difference （ t = 0. 480, P 〉 0. 05 ）. （ 2 ） Posterolateral bundle （ PLB ） ： hC = （ 46. 5 ± 3.2 ） %, hE = （45.0 ± 4. 6 ） %, there was no significant difference （ t = 0. 608, P 〉 0. 05 ） ; tC = （ 34. 2 ± 2. 5 ） % , tE = （ 37.9 ± 4. 2 ） % , there was no significant difference （ t = 0. 530, P 〉 0. 05 ）. Conclusions （ 1 ） The ACL natural footprints of the femoral insertions and the femoral tunnels of the ACL double-bundle reconstruction were identified by DSCT 3-D reconstruction. （2）The 3-D reconstruction of DSCT can help evaluating the relative locations of anatomical double-bundle reconstructed tunnels of the ACL, which can provide meaningful guidance for arthroscopic anatomical double-bundle reconstruction of the ACL.