前交叉韧带损伤对膝关节侧副韧带影响的运动还原在体稳定性研究

目的 对前交叉韧带(ACL)损伤膝关节侧副韧带长度变化进行运动还原在体稳定性研究.方法 2008年1月至6月收治8例单侧膝关节ACL断裂而对侧膝关节止常的患者,男6例,女2例;平均年龄25.3岁;在生理负重膝关节屈曲0°、15°、30°、60°和90°时采集相互垂直的二维(2D)图像,与三维CT(3D)图像在虚拟X线投射系统进行2D/3D图像配准,还原膝关节不同角度时股骨和胫骨的相对三维位置关系,并通过韧带止点还原的方法对内侧副韧带(MCL)、外侧副韧带(LCL)进行韧带长度分析,对比两侧膝关节侧副韧带的长度差异.结果 ACL损伤后在0°、15°和30°患膝MCL长度分别为(40.16±1.63)、(39.11±1.77)、(37.86±1.84)mm,健膝分别为(38.17±1.40)、(37.63±1.37)、(36.60±1.86)mm,健、患膝比较差异均有统计学意义(P<0.05);ACL损伤后在0°、15°和30°患膝LCL长度分别为(50.23±1.18)、(50.30±1.68)、(49.26±1.67)mm,健膝分别为(52.56±1.64)、(52.30±1.48)、(51.83±1.77)mm,健、患膝比较差异均有统计学意义(P<0.05).ACL损伤后60°和90°健、患膝MCL、LCL长度差异均无统计学意义(P>0.05).结论 通过2D/3D图像配准技术可以实现膝火节的运动还原并获得ACL损伤后生理屈曲过程中MCL和LCL的长度变化规律.在0°、15°和30°,ACL损伤后患膝MCL长度较健膝增加,而LCL长度较健膝缩短.

Effect of anterior cruciate ligament injury on lengths of knee collateral ligaments

Objective To study the effect of anterior cruciate ligament(ACL)injury on lengths of the medial collateral ligament(MCL)and the lateral collateral ligament(EEL)at weightbearing flexion by the technique of 2D/3D registration. Methods Eight volunteers with unilateral ACL rupture and a normal cantralateral knee were enrolled in this study.Their CT(3D)images and 2D orthogonal images of the knee were taken at weightbearing flexions of 0,15°,30°,60°and 90°.These orthogonal images were used to recreate the in vivo knee positions at each of the targeted flexion angles by the method of 2D/3D registration.The lengths of MCL and LCL were measured and compared through recreation of the bone insertions of MCL/LCL. Results At 0,15 and 30 degrees,the mean MCL lengths of the ACL injured knee were respetively(40.16±1.63),(39.1 1±1.77)and(37.86±1.84)mm,longer than those of a normal knee (38.17±1.40),(37.63±1.37)and(36.60±1.86)mm.But the mean LCL lengths of the ACL injured knee were respectively(50.23±1.18),(50.30±1.68)and(49.26±1.67)mm,shorter than those of a normal knee(52.56±1.64),(52.30±1.48)and(51.83±1.77)mm.All the difierences were statistically significant(P<0.05). Conclusions We can measure the in vivo lengths of MCL and LCL of an ACL injured knee by the technique of 2D/3D registration.At 0,15°and 30°,the MCL length of an ACL injured knee is longer than that of a normal knee,but the LCL length of an ACL injured knee is shorter than that of a normal knee.