前交叉韧带重建术后MRI评分与临床膝关节主、客观功能评分的对比研究
吴冰,陆伟,王大平,柳海峰,朱伟民,欧阳侃,李顶夫,李盛
中国临床解剖学杂志 ›› 2016, Vol. 34 ›› Issue (6) : 677-684.
前交叉韧带重建术后MRI评分与临床膝关节主、客观功能评分的对比研究
A comparative study of a MRI scoring system with traditional outcome evaluation after anterior cruciate ligament reconstruction
目的 研究利用MRI进行前交叉韧带(anterior cruciate ligament,ACL)重建术后移植物评分的方法,并探讨MRI评分结果与临床膝关节主、客观功能评分结果的相关性,为临床ACL移植物评估提供参考方法。 方法 追踪54例关节镜下ACL单束重建病例,计算MRI上ACL移植物容量(graft volume)、张力(graft tension)、信号强度(signal intensity ,SI)作为评估依据进行移植物MRI评分,同时计算MRI评分与膝关节主观功能评分(IKDC评分)、客观功能评分(KT2000)的相关性。 结果 54例患者平均随访时间(18.3±4.3)月。平均ACL移植物MRI评分及膝关节主、客观功能评分分别为75.19±7.20、85.12±9.45、83.07±12.63。MRI评分结果与膝关节主、客观功能评分结果呈正性线性相关,相关系数有统计学意义(r=0.696, P=0.001;r=0.767, P=0.000);根据MRI评分(X)及临床膝关节主、客观功能评分(Y)拟合出的回归方程具有统计学意义(P<0.01),MRI评分可以预测膝关节主、客观功能评分(R2=0.485;R2=0.589)。 结论 MRI评分可作为一种新工具,补充和完善目前ACL重建术后评判体系,从而有助于更合理地评判ACL移植物愈合情况,进一步指导康复锻炼方案的制定。
Objective To investigate an appropriate method of magnetic resonance imaging (MRI)scoring system to assess anterior cruciate ligament (ACL ) graft health at different time after ACL reconstruction, and to determineif the MRI scoring results correlate with commonlyused clinicalknee joint function outcome evaluation results. Methods Based on a subset of 54 participants enrolled in an ongoing single bundle ACL reconstruction clinical trial, AP knee laxity, IKDC and a MRI scoring system based on graft volume,signal intensity (SI) and graft tension were assessed during the follow-up, and then correlation of MRI scoring results and traditional clinical knee joint function results were determined using the linear correlation and linear regression statistical methods in SPSS software. Results All the 54 patients were followed up with a mean follow-up period of 18.3±4.3 months. The average score of AP knee laxity, IKDC and MRI assessment were 85.12±9.45, 83.07±12.63, 75.19±7.20 respectively. MRI scoring results and clinical knee joint function scoring had positively linear correlation, and the correlation coefficient was statistically significant (r=0.696, P=0.001; r=0.767,P=0.000). The regression equationfitted according to the MRI score (X) and clinical knee joint function of subjective and objective score was statistically significant (P<0.01). MRI scoring can predict traditional clinical knee joint function of subjective and objective results. Conclusions Just as subjective and objective scoring of traditional clinical knee joint function , the MRI scoring system can also be used to assess outcomes of ACL reconstruction,thus supplementing and improving current clinical evaluation methods for ACL graft health and laying a foundation for a more scientific postoperative evaluation system of ACL graft healing process.
Anterior cruciate ligament / Clinical assessment / Magnetic resonance imaging (MRI) / Function scores
[1] Lu W, Wang D, Zhu W, et al. Placement of double tunnels in ACL reconstruction using bony landmarks versus existing footprint remnant: A prospective clinical study with 2-Year follow-up [J]. Am J Sports Med, 2015, 43(5): 1206-1214.
[2] Beynnon BD, Johnson RJ, Naud S, et al. Accelerated versus nonaccelerated rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind investigation evaluating knee joint laxity using roentgen stereophotogrammetric analysis[J]. Am J Sports Med , 2011, 39(12): 2536-2548.
[3] Fleming BC, Fadale PD, Hulstyn MJ, et al. The effect of initial graft tension after anterior cruciate ligament reconstruction: a randomized clinical trial with 36-month follow-up[J]. Am J Sports Med, 2013, 41(1): 25-34.
[4] Collins NJ, Misra D, Felson DT, et al. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS)[J]. Arthritis Care Res, 2011, 63(S11): S208-S228.
[5] Biercevicz AM, Akelman MR, Fadale PD, et al. MRI volume and signal intensity of ACL graft predict clinical, functional, and patient-oriented outcome measures after ACL reconstruction[J]. Am J Sports Med, 2014, 43(3): 693-699.
[6] Alentorn-Geli E, Lajara F, Samitier G, et al. The transtibial versus the anteromedial portal technique in the arthroscopic bone–patellar tendon–bone anterior cruciate ligament reconstruction[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(8): 1013-1037.
[7] Mohtadi NG, Chan DS, Dainty KN, et al. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults[J]. Cochrane Database Syst Rev, 2011, (9): CD005960.
[8] Suomalainen P, Moisala AS, Paakkala A, et al. Double-bundle versus single-bundle anterior cruciate ligament reconstruction: randomized clinical and magnetic resonance imaging study with 2-year follow-up[J]. Am J Sports Med, 2011, 39(8): 1615-1622.
[9] Fleming BC, Vajapeyam S, Connolly SA, et al. The use of magnetic resonance imaging to predict ACL graft structural properties[J]. J Biomech, 2011, 44(16):2843-2846.
[10] Biercevicz AM, Miranda DL, Machan JT, et al. In Situ, noninvasive, T2*-weighted MRI-derived parameters predict ex vivo structural properties of an anterior cruciate ligament reconstruction or bioenhanced primary repair in a porcine model [J]. Am J Sports Med, 2013, 41(3): 560-566.
[11] Weiler A1, Peters G, Mäurer J, et al. Biomechanical properties and vascularity of an anterior cruciate ligament graft can be predicted by contrast-enhanced magnetic resonance imaging—a two-year study in sheep[J]. Am J Sports Med, 2001, 29(6): 751-761.
[12] Biercevicz AM, Murray MM, Walsh EG, et al. T2 * MR relaxometry and ligament volume are associated with the structural properties of the healing ACL [J]. J Orthop Res, 2014, 32(4): 492-499.
[13] Hakozaki A, Niki Y, Enomoto H, et al. Clinical significance of T2*-weighted gradient-echo MRI to monitor graft maturation over one year after anatomic double-bundle anterior cruciate ligament reconstruction: A comparative study with proton density-weighted MRI[J]. Knee, 2015, 22(1): 4-10.
[14] Ebrahimzadeh MH, Makhmalbaf H, Golhasani-Keshtan F, et al. The International Knee Documentation Committee (IKDC) Subjective Short Form: a validity and reliability study[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
[15] 余家阔,敖英芳,于长隆,等. 关节镜下腘绳肌腱部分重建、单束重建和双束重建前交叉韧带的疗效比较[J].中华创伤骨科杂志,2007,6(9):523-528.
[16] 吴冰,陆伟,王大平,等. 基于MRI快速建立前交叉韧带三维数字化模型初步报道[J]. 中国临床解剖学杂志,2014,32(5):571-575.
[17] Sanchis-Alfonso V, Martinez-Sanjuan V, Gastaldi-Orquin E. The value of MRI in the evaluation of the ACL deficient knee and in the post-operative evaluation after ACL reconstruction [J]. Eur J Radiol, 1993, 16(2): 126-130.
[18] Saupe N, White LM, Chiavaras MM, et al. Anterior cruciate ligament reconstruction grafts: MR imaging features at long-term follow-up--correlation with functional and clinical evaluation [J]. Radiology, 2008, 249(2): 581-590.
[19] 窦永峰,耿晓鹏,陈百成,等.磁共振成像评价不同材料前交叉韧带重建后移植物完整性: 和关节镜再观察的比较[J].中国组织工程研究与临床康复,2010,14(12): 2253 -2256.
[21] Kondo E, Yasuda K. Second-look arthroscopic evaluations of anatomic double-bundle anterior cruciate ligament reconstruction: relation with postoperative knee stability [J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(11): 3163-3167.
[22] Lee JH, Bae DK, Song SJ , et al. Comparison of clinical results and second-look arthroscopy findings after arthroscopic anterior cruciate ligament reconstruction using 3 different types of grafts [J]. Arthroscopy, 2010, 26(1): 41-49.
[23] van Meer BL, Oei EH, Bierma-Zeinstra SM, et al. Are Magnetic Resonance Imaging Recovery and Laxity Improvement Possible After Anterior Cruciate Ligament Rupture in Nonoperative Treatment [J]. Arthroscopy, 2014, 30(9): 1092-1099.
广东省科技计划项目 (2014A020212656,2015 A030401017); 深圳市科技研发计划项目 (JCYJ20140414170 821213,JCYJ20140414170821157)
/
〈 |
|
〉 |