论文部分内容阅读
目的:通过对前交叉韧带(aterior cruciate ligament,ACL)断裂患者以及未断裂人群的膝关节股骨外旋角度(femur tibia angle,FTA)及胫骨结节到滑车沟距离(tibial tubercle to trochlear Groove,TT-TG)进行核磁测量,研究ACL断裂患者胫骨与股骨相对旋转角度的变化,分析探讨其与髌股关节软骨损伤变化的关系.方法:本研究选取50例膝关节ACL断裂患者作为研究组,50例ACL未断裂人群作为对照组进行核磁测量,测量的参数包括:FTA、TT-TG.ACL断裂患者在接受ACL重建术前与术后分别进行测量记录.对结果进行方差分析和t检验.结果:核磁测量结果显示ACL断裂患者重建术前FTA平均6.5°±6.1°,重建术后FTA平均6.0°±5.6°,均明显大于对照组的3.6°±4.9° (P=0.0003,P=0.033),但是FTA在重建术前与术后没有明显变化.ACL断裂患者重建术前的TT-TG平均为6.4 mm±3.3 mm,重建术后为6.9 mm±4.0 mm,对照组为6.3 mm±3.6 mm,三组数据之间对比没有明显差异(P=0.678).此外,所有ACL断裂患者均接受了重建术后的关节镜二次探查,发现髌股关节软骨损伤Outerbridge分级加重的患者有26例,未加重24例,这两组患者的FTA、TT-TG结果均无明显差别.结论:ACL重建术后患者在伸膝0度位的静态股骨外旋角度并不能完全恢复到正常膝关节的水平.ACL重建术后髌股关节软骨损伤加重是由多因素导致的,结合ACL重建术后再次关节镜检的结果,未发现髌股关节软骨损伤Outerbridge分级增加与ACL重建术后股骨相对胫骨外旋角度的增加有显著相关性.另外,ACL重建术后股骨外旋角度大于正常膝关节并不能提示ACL再断裂.“,”Objective To compare the femur tibia angle(FTA) and tibia tubercle to trochlear groove (TT-TG) measured on the magnetic resonance imaging(MRI) between patients with anterior cruciate ligament(ACL) rupture and healthy controls with intact ACL,and to observe the change of the tibia-femur rotation and explore its relationship with the patellofemoral cartilage injury.Methods Fifty patients with ACL ruptures were divided into an experimental group,while another 50 healthy counterparts were chosen into a control group.All subjects were given MRI to get FTA and TT-TG.For the experimental group,all parameters were measured before and after ACL reconstruction.The results were analyzed by variance analysis and t test.Results MRI measurements showed that the average FTA in the experimental group was 6.5° ± 6.1° and 6.0° ± 5.6° before and after the ACL reconstruction,significantly higher than that in the control group,which was 3.6° ± 4.9° (P=0.0003 and P=0.033,respectively).No significant differences were found in the average TT-TG of the experimental group,6.4 ± 3.3 mm before ACL reconstruction and 6.9 mm ± 4.0 mm after ACL reconstruction,and that of the control group,6.3 ± 3.6 mm(P=0.678).Moreover,all patients in the experimental group underwent a second check under the arthroscopy,which revealed that the patellofemoral cartilage injury was aggravat ed in 26 patients measured by the Outerbridge grading.However,there was no significant difference in FTA and TT-TG between patients with and without aggravated patellofemoral cartilage degeneration.Conclusions After ACL reconstruction,the external rotation angle of the knee could not completely recover to the normal level with the knee extension at 0°.Patellofemoral cartilage degeneration after the ACL reconstruction is caused by many factors.The results of the second arthroscopy after the ACL reconstruction find no relationship between patellofemoral cartilage degeneration and the increased tibia external rotation angle relative to the femur.Moreover,after the ACL reconstruction,if the femur tibia angle is bigger than the range of motion of the knee,it cannot be concluded that the anterior cruciate ligament is reruptured.