目的 利用CT三维重建技术精准测量前交叉韧带（Anterior cruciate ligament，ACL）股骨直接止点骨块面积，分析其与性别、侧别等解剖学参数的关联性，评估其在解剖单束重建术中对股骨骨道定位的指导价值，并与IDEAL（isometric，等距性；direct insertion，直接纤维止点；eccentrically located，偏心；anatomical，解剖性；low rupture risk，低张力）定位方法进行对比。 方法 回顾2024年2月至2025年8月本院553例成年患者（男240例，女260例；左膝246例，右膝307例）膝关节CT三维重建影像，采用西门子syngo.via软件重建图像，结合Bernard四格表法测量ACL股骨直接止点骨块面积、形态特征及空间分布，进行统计学分析。 结果 ACL股骨直接止点骨块面积为（49.86±8.99）mm²，集中分布于股骨外侧髁内侧面后软骨缘与住院医师嵴之间。止点形态以凹陷型为主（89.9%），空间分布以b区（上前象限，40.5%）、d区（下前象限，34.2%）为主。男性骨块面积（52.14±8.63） mm²大于女性（48.12±8.83）mm²（P<0.001）；左右膝ACL股骨直接止点骨块面积无显著差异。 结论 CT三维重建可清晰呈现ACL股骨直接止点解剖结构，为ACL重建手术提供可靠影像支撑。止点核心分布区域与IDEAL定位理念相符，且存在明显性别差异，术中需遵循个体化定位原则。本研究可为IDEAL临床定位提供解剖及影像学依据。
Abstract
Objective To measure precisely the femoral direct insertion bone area of the anterior cruciate ligament (ACL) by using CT three‑dimensional reconstruction, to analyze its correlation with anatomical parameters such as gender and side, to evaluate its clinical guidance value for femoral tunnel positioning in anatomical single-bundle reconstruction, and to conduct a systematic comparison with the IDEAL (isometric, direct insertion, eccentrically located, anatomical, low rupture risk) point positioning method. Methods The 3D CT reconstruction images of knee joints of 553 adult patients (240 males, 260 females; 246 left knees, 307 right knees) admitted to our hospital from February 2024 and August 2025 were retrospectively reviewed. The images were reconstructed using Siemens syngo.via software, and the area, morphological characteristics, and spatial distribution of the femoral direct insertion bone block of ACL were measured using Bernard four-cell table method, followed by statistical analysis. Results The bone block area at the femoral direct attachment site of ACL was (49.86±8.99) mm², concentrated between the posterior cartilage margin and the resident's ridge on the medial surface of lateral femoral condyle. The termination point morphology was mainly of the concave type (89.9%), and the spatial distribution was mainly in zone b (upper front quadrant, 40.5%) and zone d (front lower quadrant, 34.2%), accounting for a combined total of 74.7%. The bone block area in males (52.14±8.63 mm²) was significantly larger than that in females (48.12±8.83 mm²) (P<0.001), with no significant difference in the area between the left and right knee sides. Conclusions CT 3D reconstruction can clearly display the anatomical structure of the direct femoral attachment point of ACL, providing reliable imaging support for ACL reconstruction surgery. The distribution area of the stop point core is consistent with IDEAL point positioning concept, and there are significant gender anatomical differences, therefore, individualized localization principles must be followed during surgery. This study provides anatomical and imaging evidence for the clinical localization of the IDEAL point positioning method.
关键词
CT三维重建； /
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前交叉韧带； /
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股骨直接止点； /
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解剖单束重建； /
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IDEAL定位
Key words
CT 3D reconstruction; /
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Anterior cruciate ligament; /
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Direct femoral insertion; /
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Anatomical single-bundle reconstruction; /
IDEAL (isometric, direct insertion, eccentrically located, anatomical, low rupture risk) point
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基金
国家自然科学基金面上项目（82571034）；福建省自然科学基金（2022J011434）
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