前交叉韧带损伤重建术后及随访的弥散张量成像观测

目的　为前交叉韧带重建术后的预后评估提供影像数据。 方法　选取新乡医学院附属医院膝关节弥散张量成像正常者100例和前交叉韧带Ⅲ、Ⅳ级损伤重建61例及随访57例，划分前交叉韧带损伤、重建处及正常组相应部位的感兴趣区，测量各向异性分数（fractional anisotropy，FA）、表观弥散系数（apparent diffusion coefficient，ADC），生成纤维示踪图像。 结果　前交叉韧带术前和术后1周、3个月的FA值和ADC值为（0.395±0.047）、（0.541±0.056）、（0.542±0.058）和（2.791±0.336）×10-3 mm2 / s、（2.263±0.224）×10-3 mm2 / s、（2.028±0.341）×10-3 mm2 / s，术后1周与3个月FA值差异无统计学意义，其他组间FA、ADC值差异有统计学意义。前交叉韧带损伤重建术后随访3个月、6个月、1年和正常组的FA值、ADC值为（0.542±0.058）、（0.595±0.056）、（0.684±0.059）、（0.577±0.064）和（2.028±0.341）×10-3 mm2 / s、（1.699±0.175）×10-3 mm2 / s、（1.375±0.151）×10-3 mm2 / s、（1.324±0.160）×10-3 mm2 / s，随访6个月与正常组FA值和随访1年与正常组ADC值差异无统计学意义，其他组间FA、ADC值差异有统计学意义。 结论　弥散张量成像能客观反映前交叉韧带重建术后的微观结构变化，在预后评估中有重要的诊断价值。

Diffusion tensor imaging observation in the postoperative and follow-up of anterior cruciate ligament reconstruction

Objective　To provide image data for prognosis evaluation after the anterior cruciate ligament reconstruction.　Methods　One hundred cases of normal knee joint and sixty-one cases of patients with Ⅲ grade, Ⅳ grade in reconstruction of the anterior cruciate ligament injury and fifty-seven cases of follow-up patients in the Affiliated Hospital of Xinxiang Medical University were selected by diffusion tensor imaging. The regions of interest of the anterior cruciate ligament injury, reconstruction and the corresponding position of normal group were divided. The fractional anisotropy (FA) values and apparent diffusion coefficient (ADC) values were measured, and the tractography images were generated.　Results　The preoperative and 1 week, 3 months postoperative FA values and ADC values of anterior cruciate ligament reconstruction were (0.395±0.047), (0.541±0.056), (0.542±0.058) and (2.791±0.336)×10-3 mm2/s, (2.263±0.224)×10-3 mm2/s, (2.028±0.341)×10-3mm2/s, respectively. There was no significant difference in the FA values between the 1 week and 3 months after the operation, there was statistical significance in the FA values and ADC values among other groups. The FA values and ADC values were (0.542±0.058), (0.595±0.056), (0.684±0.059), (0.577±0.064) and (2.028±0.341)×10-3 mm2/s, (1.699±0.175)×10-3 mm2/s, (1.375±0.151)×10-3 mm2/s, (1.324±0.160) ×10-3mm2/s at 3 months, 6 months, 1 year in postoperative follow-up and the normal group. There was no significant difference in the FA values between the 6 months in postoperative follow-up and the normal group, and the ADC values between the 1 year in postoperative follow-up and the normal group, there was statistical significance in the FA values and ADC values among other groups. Conclusions The diffusion tensor imaging can objectively reflect the microstructural changes after anterior cruciate ligament reconstruction, it has important diagnostic value in the prognosis evaluation.