[1]毛光兰,吕　方,杨荣丽,等.膝关节前交叉韧带重建术后弥散张量成像观测[J].新乡医学院学报,2020,37(12):1173-1176.[doi:10.7683/xxyxyxb.2020.12.016]
　MAO Guanglan,LYU Fang,YANG Rongli,et al.Diffusion tensor imaging of knee joint after anterior cruciate ligament reconstruction[J].Journal of Xinxiang Medical University,2020,37(12):1173-1176.[doi:10.7683/xxyxyxb.2020.12.016]
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膝关节前交叉韧带重建术后弥散张量成像观测
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年12
页码:
1173-1176
栏目:
临床研究
出版日期:
2020-12-05

文章信息/Info

Title:
Diffusion tensor imaging of knee joint after anterior cruciate ligament reconstruction
作者:
毛光兰1; 吕　方2; 杨荣丽3; 付升旗3; 王庆志3
（1.新乡医学院第三附属医院康复科，河南　新乡　453003；2.新乡医学院第三附属医院磁共振室，河南　新乡　453003；3.新乡医学院解剖学教研室，河南　新乡　453003）
Author(s):
MAO Guanglan1; LYU Fang2; YANG Rongli3; FU Shengqi3; WANG Qingzhi3
（1.Department of Rehabilitation,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;2.Department of MRI,the Third Affiliated Hospital of Xinxiang Medical University,Xinxiang 453003,Henan Province,China;3.Department of Anatomy,Xinxiang Medical University,Xinxiang 453003,Henan Province,China）
关键词:
前交叉韧带重建; 弥散张量成像; 纤维示踪成像; 磁共振成像; 膝关节
Keywords:
anterior cruciate ligament reconstruction; diffusion tensor imaging; tractography imaging; magnetic resonance imaging; knee joint
分类号:
R686
DOI:
10.7683/xxyxyxb.2020.12.016
文献标志码:
A
摘要:
目的　比较不同的影像学检查方法评估膝关节前交叉韧带损伤重建术后手术效果的效能。方法　选择2017年1月至2018年9月新乡医学院第三附属医院收治的膝关节前交叉韧带Ⅲ、Ⅳ级撕裂伤患者61例为研究对象。患者均接受单束自体肌腱重建术,术后根据关节的稳定性分为稳定组（n=54)和不稳定组(n=7)。术前及术后1周、3个月进行膝关节磁共振成像（MRI）及弥散张量成像扫描。在工作站划分前交叉韧带损伤及重建处的感兴趣区，测量感兴趣区的各向异性分数值（FA）和表观弥散系数值（ADC），生成纤维示踪图像。比较稳定组和不稳定组患者的FA、ADC值及FA和ADC、纤维示踪成像、MRI评估前交叉韧带损伤重建术后手术效果的效能。结果　术后1周，稳定组与不稳定组患者FA、ADC比较差异均无统计学意义（P>0.05）。MRI评估手术效果的灵敏度、特异度、准确度、阳性预测值、阴性预测值均低于纤维示踪成像（P<0.05）。FA和ADC的灵敏度、特异度、准确度、阴性预测值均低于纤维示踪成像（P<0.05）；纤维示踪成像与FA和ADC的阳性预测值比较差异无统计学意义（P>0.05）。MRI的灵敏度、特异度、准确度、阴性预测值均低于FA和ADC（P<0.05）；MRI与FA和ADC的阳性预测值比较差异无统计学意义（P>0.05）。前交叉韧带损伤Ⅲ、Ⅳ级患者术后1周、3个月的FA均高于术前，ADC均低于术前（P<0.05）；前交叉韧带损伤Ⅲ、Ⅳ级患者术后1周与3个月的FA比较差异无统计学意义（P>0.05），3个月时的ADC均低于术后1周（P<0.05）。术前，前交叉韧带损伤Ⅲ级患者FA高于Ⅳ级患者，ADC低于Ⅳ级患者（P<0.05）；术后1周、3个月，前交叉韧带损伤Ⅲ级与Ⅳ级患者的FA和ADC比较差异均无统计学意义（P>0.05）。结论　弥散张量成像的FA和ADC能够客观反映前交叉韧带损伤重建术后的微观结构变化，纤维示踪成像可直观显示重建术后早期膝关节的稳定性，可以为临床二次手术或早期康复治疗提供可靠的影像学信息。
Abstract:
Objective　To compare the efficacy of different imaging method in evaluating the surgical effect of anterior cruciate ligament reconstruction of the knee joint.Methods　Sixty-one patients with grade Ⅲ and grade Ⅳ anterior cruciate ligament laceration in the Third Affiliated Hospital of Xinxiang Medical University from January 2017 to September 2018 were selected as the research objects.All patients underwent single bundle autologous tendon reconstruction operation.The patients were divided into stable group (n=54) and unstable group (n=7) according to the stability of the joint.The knees joint were scanned by magnetic resonance imaging (MRI) and diffusion tensor imaging before operation and 1 week,3 months after operation;the region of interest of anterior cruciate ligament injury and reconstruction position was divided at the workstation,and the fractional anisotropy(FA) values,apparent diffusion coefficient(ADC) values of the region of interest were measured;then the tractography image was generated.The FA,ADC values of patients were compared between the stable group and the unstable group and the efficacy of FA and ADC,fiber tracer imaging and MRI in evaluating the surgical effects of anterior cruciate ligament reconstruction was compared.Results　There was no significant difference in the FA and ADC of patients between the stable group and the unstable group at one week after operation(P>0.05).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MRI in evaluating the surgical effect were lower than those of fiber tracer imaging (P<0.05).The sensitivity,specificity,accuracy and negative predictive value of FA and ADC in evaluating the surgical effect were lower than those of fiber tracer imaging (P<0.05);there was no significant difference in the positive predictive value between fiber tracer imaging and FA,ADC (P> 0.05).The sensitivity,specificity,accuracy and negative predictive value of MRI were lower than those of FA and ADC (P<0.05);there was no significant difference in the positive predictive value between MRI and FA,ADC (P>0.05).The FA of patients with anterior cruciate ligament injury of grade Ⅲ and Ⅳ at 1 week and 3 months after operation was higher than that before operation,and the ADC was lower than that before operation (P<0.05).There was no significant difference in FA of patients with anterior cruciate ligament injury of grade Ⅲ and Ⅳ between 1 week and 3 months after operation (P>0.05);the ADC of grade Ⅲ and Ⅳ patients at 3 months after operation was lower than that at 1 week after operation (P<0.05).Before operation,the FA of patients with anterior cruciate ligament injury of grade Ⅲ was higher than that with grade Ⅳ,and the ADC was lower than that with grade Ⅳ (P<0.05);there was no significant difference in FA and ADC between grade Ⅲ and grade Ⅳ patients at 1 week and 3 months after operation (P>0.05).Conclusion　The FA and ADC values of diffusion tensor imaging can objectively reflect the microstructural changes after reconstruction of anterior cruciate ligament injury,the fiber tracer imaging can visually display the stability of knee joint in the early stage after reconstruction,it can provide the reliable imaging information for clinical secondary operation or early rehabilitation treatment.

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更新日期/Last Update: 2020-12-05