【摘要】 背景:儿童和青少年处于生长发育阶段,采用与成人相同的前交叉韧带重建方式,易诱发包括肢体长度差异、移植物失败率高需再次外科手术介入等并发症,同时骨关节炎的发生也会提前。目的:探讨儿童、青少年与成人前交叉韧带在膝关节MRI上的解剖学特征差异,为儿童和青少年前交叉韧带的重建提供解剖学基础。方法:回顾性分析2016年10月至2018年10月在青岛市市立医院行膝关节MRI检查的受试者,分为儿童青少年组和成人组,两组各入组48例。分别测量两组受试者前交叉韧带在矢状面上与胫骨及股骨的夹角及前交叉韧带胫骨止点的位置,冠状面上前交叉韧带与胫骨的夹角及前交叉韧带胫骨止点、股骨止点的位置,以及轴位上股骨止点的位置。并且对儿童、青少年前交叉韧带测量所得数据进行处理,绘制儿童、青少年前交叉韧带形态及位置的生长曲线,分析其生长变化规律。结果与结论:(1)儿童青少年组的前交叉韧带矢状面与股骨夹角(t=-2.906,P <0.05)、前交叉韧带矢状面与胫骨的夹角(t=-10.280,P <0.05)、前交叉韧带冠状面与胫骨的夹角(t=-5.714,P <0.05)均小于成人组,差异有显著性意义;(2)儿童青少年组前交叉韧带胫骨冠状面比值(t=-7.263,P <0.05)、前交叉韧带股骨轴位面比值(t=-7.378,P <0.05)均小于成人组,差异有显著性意义;(3)儿童青少年组前交叉韧带胫骨矢状面比值(t=-1.588,P> 0.05)、前交叉韧带股骨冠状面比值(t=-1.647,P> 0.05)与成人组比较差异无显著性意义;(4)生长曲线结果显示,在生长发育过程中,儿童青少年组前交叉韧带在矢状面上与股骨和胫骨的夹角及在冠状面上与胫骨的夹角由小变大(P <0.05);胫骨止点在冠状位上的相对位置由小变大,提示在生长发育过程中,胫骨止点在冠状面上相对胫骨平台内侧来说由内向外移动(P <0.05);(5)股骨止点在轴位上的相对位置由小变大,提示在生长发育过程中,股骨止点在轴位上相对于股骨外侧髁来说是由外向内移动的(P <0.05);(6)矢状面上胫骨止点和冠状面上股骨止点儿童青少年组与成人组无明显差异(P﹥0.05)。更多还原

【Abstract】 BACKGROUND: Children and adolescents are in the growth and development stage, so the use of the same reconstruction methods as adults is easy to induce complications including limb length differences, high graft failure rate and re-surgical intervention. Simultaneously, the occurrence of osteoarthritis will also be advanced. OBJECTIVE: To explore the anatomical characteristics of the anterior cruciate ligament between children, adolescents and adults on MRI, and to provide an anatomical basis for the reconstruction of the anterior cruciate ligament in children and adolescents.METHODS: A retrospective analysis of patients undergoing knee MRI examination in Qingdao Municipal Hospital from October 2016 to October 2018 was conducted. These patients were divided into child and adolescent group and adult group(n=48 per group). The angle between the anterior cruciate ligament and the tibia and femur on the sagittal plane and the position of the anterior cruciate ligament tibial insertion, the angle between the anterior cruciate ligament and the tibia on the coronal plane, the tibial insertion of the anterior cruciate ligament and femur, and the position of the femur stop point on the axial position were measured in both groups. The data obtained from the measurement of the anterior cruciate ligament of children and adolescents were processed. The growth curves of the shape and position of the anterior cruciate ligament of children and adolescents were drawn, and the law of its growth changes was analyzed. RESULTS AND CONCLUSION:(1) The angle between the sagittal plane of the anterior cruciate ligament and the femur(t=-2.906, P < 0.05), the angle between the sagittal plane of the anterior cruciate ligament and the tibia(t=-10.280, P < 0.05), the anterior cruciate ligament angle between the coronal plane and the tibia(t=-5.714, P < 0.05) were smaller in the child and adolescent group than those of the adult group, and the difference was significant.(2) The ratio of the tibia coronal plane of the anterior cruciate ligament(t=-7.263, P < 0.05) and the ratio of the anterior cruciate ligament and femur axial plane(t=-7.378, P < 0.05) were lower in the child and adolescent group than those of the adult group, and the difference was significant.(3) There was no significant difference in the anterior cruciate ligament and tibia sagittal plane ratio(t=-1.588, P > 0.05) and anterior cruciate ligament and femoral coronal surface ratio(t=-1.647, P > 0.05) between the child and adolescent group and the adult group.(4) The growth curve results showed that during the growth and development, the angle between the anterior cruciate ligament and the femur and tibia on the sagittal plane and the angle with the tibia on the coronal plane changed from small to large(P < 0.05). The relative position of the tibial insertion in the coronal position changed from small to large, which indicates that during the growth and development, the tibial insertion moved from inside to outside relative to the inside of the tibial plateau on the coronal plane(P < 0.05).(5) The relative position of femoral insertion in the axial position changed from small to large, suggesting that during the growth and development, the femoral insertion moved from the outside to the inside relative to the lateral femoral condyle(P < 0.05).(6) There was no significant difference in the tibial insertion and the femoral insertion between the child and adolescent group and adult group(P > 0.05).更多还原