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。
Abstract
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.
关键词
前交叉韧带重建 /
前交叉韧带损伤 /
弥散张量成像 /
纤维示踪成像 /
MRI
Key words
Anterior cruciate ligament reconstruction /
Anterior cruciate ligament injury /
Diffusion tensor imaging /
Tractography imaging /
Magnetic resonance imaging
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参考文献
[1] 叶英文, 苏尚贤, 谢海莲, 等. 关节镜下应用自体腘绳肌腱重建前交叉韧带的临床分析[J]. 中华关节外科杂志, 2013, 7(3): 350-353. DOI: 10.3877/cma.j.issn.1674-134X.2013.03.014.
[2] 邓军, 梁碧玲, 陈建宇, 等. 前交叉韧带重建术后三维MRI表现[J]. 中华放射学杂志, 2011, 45(12):1143-1146.DOI:10.3760/cma.j.issn.1005- 1201. 2011.12.017.
[3] Van DP, Vanhoenacker FM, Gielen JL, et al. Three tesla magnetic resonance imaging of the anterior cruciate ligament of the knee: can we differentiate complete from partial tears[J]? Skeletal Radiol, 2011, 40(6): 701-707. DOI: 10.1007/s00256-010-1044-8.
[4] 陈立勋, 赵衡, 李劲松, 等. 健康人前交叉韧带的扩散张量成像及其与MRI的比较[J]. 中南大学学报(医学版), 2013, 38(6): 610-616. DOI: CNKI: SUN:HNYD.0.2013-06-013.
[5] Yang XF, Li M, Chen DY, et al. Diffusion tensor imaging for anatomical and quantitative evaluation of the anterior cruciate ligament and ACL grafts: a preliminary study[J]. J Comput Assist Tomogr, 2014, 38(4): 489-494. DOI: 10.1097/RCT.0000000000000078.
[6] 李显, 赵力, 王淑丽, 等. 前交叉韧带损伤的关节镜与MRI诊断分级研究[J]. 中国医学前沿杂志(电子版), 2011, 3(1): 61-65. DOI: 10.3969/j.issn.1674-7372.2011.01.016.
[7] 陈斌, 曾昭池, 阳波, 等. 自体移植物和异体移植物在膝关节前后交叉韧带重建术中的应用效果对比[J]. 中国医学前沿杂志, 2016, 8(10): 60-63. DOI: 10.12037/YXQY.2016.10-16.
[8] Ntoulia A, Papadopoulou F, Ristanis S, et al. Revascularization process of the bone-patellar tendon-bone autograft evaluated by contrast-enhanced magnetic resonance imaging 6 and 12 months after anterior cruciate ligament reconstruction[J]. Am J Sports Med, 2011, 39(7): 1478-1486. DOI: 10.1177/0363546511398039.
[9] 常利, 胡文清, 张仲, 等. 自体跟腱重建与聚乙烯对苯二酸酯人工韧带重建前交叉韧带在骨隧道内愈合情况的比较[J]. 广东医学, 2017, 38(18): 2755-2759. DOI: CNKI: SUN:GAYX.0.2017-18-004.
[10]徐丛, 陈永良, 吕永明, 等. ACL断裂单束解剖重建及胫骨隧道扩大的临床研究[J]. 中国临床解剖学杂志, 2016, 34(5): 572-576. DOI: 10.13418/j.issn.1001-165x.2016.05.019.
[11]袁锋, 张屹峰, 刘铮, 等. 骨隧道内放置不同长度自体肌腱重建前交叉韧带的组织学研究[J]. 同济大学学报(医学版), 2018, 39(4): 41-45. DOI: 10.16118/j.1008-0392.2018.04.008.
[12]王永健, 敖英芳. 自体半腱肌腱移植重建前交叉韧带移植物组织学变化的实验研究[J]. 中国运动医学杂志, 2004, 23(6): 609-612. DOI: 10.3969/j.issn.1000-6710.2004.06.002.
[13]赵磊, 王创利, 田守进, 等. 自体肌腱与同种异体肌腱重建治疗前交叉韧带损伤效果分析[J]. 中国骨与关节损伤杂志, 2016, 31(8): 856-858. DOI: 10.7531/j.issn.1672-9935.2016.08.023.
[14]王成文, 沙海燕, 许胜, 等. 前交叉韧带体部断裂修复的动物试验[J]. 双足与保健, 2019, 12(1): 107-108. DOI: CNKI: SUN:SZBJ.0.2019-12-058.
[15]Jones J, Lerner A, Kim PE, et al. Diffusion tensor imaging in the assessment of ossification of the posterior longitudinal ligament: a report on preliminary results in 3 cases and review of the literature[J]. Neurosurg Focus, 2011, 30(4): 314-316. DOI: 10.3171/2011.1.FOCUS10262.