解剖型前交叉韧带重建术前、术后MRI与正常膝关节MRI比较分析

目的：通过分析解剖型前交叉韧带重建术前、术后的MRI与正常膝关节MRI比较,探讨前交叉韧带重建术后能否恢复正常的解剖结构。方法回顾性分析2008年3月—2011年9月收治的30例前交叉韧带断裂患者(手术组),行解剖型前交叉韧带重建术。按照国际膝关节评分委员会( IKDC)、Lysholm膝关节评分标准评价疗效,观察膝关节稳定性及活动度。术前及术后常规检查MRI(3.0TGE,4 mm层厚),前叉韧带信号评定及进行Blumensaat角、矢状位ACL角、PCL角、PCL指数测定、胫骨前移测定与30例正常膝关节(正常组) MRI的相应指标进行比较。结果术后伸屈活动度正常,前抽屉试验均阴性。 Lachman试验Ⅰ度阳性3例,Ⅱ度阳性1例；轴移试验阳性3例。术后IKDC膝关节主观评分及Lysholm评分均高于术前(P<0．05)。前交叉韧带信号按Rak's方法评定：其中1级为27例(优),2级为3例(中)。 ACL角手术组术前、术后与正常组间比较差异无统计学意义(P>0．05)。手术组术后与正常组Blumensaat角、PCL指数、胫骨前移均较术前降低( P<0．05),手术组术后与正常组间比较无统计学意义( P>0．05)。手术组术后、正常组PCL夹角均较术前增大(P<0．05),手术组术后PCL夹角明显高于正常组(P<0．05)。结论通过解剖型重建前交叉韧带的术前、术后MRI与正常MRI比较,说明解剖型前交叉韧带重建能够很好恢复膝关节前后向及旋转稳定性。

Comparative Analysis of MRI Results between Preoperative and Postoperative Anatomic ACL Reconstruction and Normal Knee MRI

Objective To compare and analyze magnetic resonance imaging ( MRI) results between preoperative and postoperative anatomic anterior cruciate ligament ( ACL) reconstruction and normal knee MRI so as to discuss recov-ery of normal structure by ACL reconstruction. Methods Clinical data of 30 ACL rupture patients with anatomical ACL reconstruction ( operation group) during March 2008 and September 2011 was respectively analyzed. Curative effect was evaluated using international commission on knee score ( IKDC) and Lysholm knee joint scoring, and stability and mobili-ty of knee joints were assessed. Preoperative and postoperative routine examination of MRI (3. 0TGE, 4mm thickness) including ACL signal evaluation and detections of Blumensaat angle, sagittal ACL angle, posterior cruciate ligament ( PCL) angle, PCL index and tibia antedisplacement were performed, and then the results were compared with those of MRI indexes of 30 cases of normal knees ( normal group) . Results All postoperative patients had normal flexed mobili-ty, and results of anterior drawer test were negative. Lachman test showed positive in 3 patients with degreeⅠand 1 pa-tient with degree Ⅱ;3 patients had positive pivot shift test. Values of postoperative IKDC subjective and Lysholm knee joint scores were higher than those before surgery (P<0. 05). Evaluation of ACL signal by Rak' s method showed that there were 27 patients with class 1 ( excellent) and 3 patients with class 2 ( moderate) . There were no significant differ-ences in ACL angle among preoperative, postoperative in operation group and normal groups (P>0. 05). Values of Blu-mensaat angle, PCL index and tibia antedisplacement in postoperative operation and normal groups were lower than those in preoperative operation group (P<0. 05), but there were no significant differences in the vales between postoperative operation and normal groups ( P>0. 05 ) . Values of PCL included angle in postoperative operation and normal groups were higher than that in preoperative operation group (P<0. 05), and the value in postoperative group was significantly higher than that in normal group (P<0. 05). Conclusion Anatomical ACL reconstruction can well recover anteroposte-rior and rotational stability of knee joint by comparison analysis of MRI results between preoperative and postoperative an-atomic single-bundle ACL reconstruction and normal knee MRI.