基于MRI二維影像下股骨髁間窩的三維可視化研究_《中國修復重建外科雜志》

作者：

李彥林 ¹ , 許鵬 ^1# , 韓睿 ² , 王建偉 ¹ , 何川 ¹ , 王國梁 ¹ , 仝路 ¹ , 胡猛 ¹

昆明醫科大學第一附屬醫院（昆明，650032）1運動醫學科，2內科;

關鍵詞：

MRI 三維重建髁間窩成形術虛擬手術前交叉韌帶重建

視頻：

導出 下載 收藏 掃碼 引用

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

目的通過MRI二維影像對股骨髁間窩進行三維重建及測量，探討虛擬股骨髁間窩成形術的可行性。方法2009年9月－12月募集健康志愿者30名，男、女各15名，年齡20～30歲，身高150～185 cm，體重45～74 kg。排除膝關節疾病和手術史。根據性別不同將研究對象分為男性組和女性組，并將同性別的膝關節分為左膝及右膝2個亞組。對30名志愿者行雙膝關節MRI掃描，將MRI二維圖像導入交互式醫學影像控制系統Mimics10.01，并對膝關節進行三維重建，通過三維圖像測量獲取髁間窩相關解剖學數據：髁間窩寬度（notch width，NW），內、外股骨髁寬度（condylar width，CW），髁間窩指數（notch width index，NWI）。收集2010年1月－3月收治的前交叉韌帶（anterior cruciate ligament，ACL）損傷患者膝關節三維圖像，篩選出4例髁間窩狹窄（NWI≤0.2）的患者，在患者膝關節三維圖像上虛擬髁間窩成形術，計算截骨厚度，并在ACL重建術中實施，評估移植物與髁間窩的撞擊情況。結果男性組與女性組雙側股骨髁間窩三維模型的NW、CW比較差異均有統計學意義（P lt; 0.05），NWI比較差異無統計學意義（P gt; 0.05）。男性組內及女性組內左、右膝股骨髁間窩三維模型的NW、CW、NWI比較差異均無統計學意義（P gt; 0.05）。在ACL重建術中，根據術前測量結果行髁間窩成形術后患者的NWI達正常值（NWI gt; 0.22），韌帶重建后關節鏡觀察以及術后3個月隨訪時行基于MRI二維圖像的數字化三維重建膝關節模型并測量發現重建韌帶與髁間窩無撞擊。結論計算機三維重建模型與實體的髁間窩形態有較高相似度，NWI可較好地反映髁間窩狹窄程度；計算機虛擬髁間窩成形術可為ACL重建提供術前參考，以避免術后移植物與髁間窩的撞擊。

引用本文： 李彥林,許鵬,韓睿,王建偉,何川,王國梁,仝路,胡猛. 基于MRI二維影像下股骨髁間窩的三維可視化研究. 中國修復重建外科雜志, 2012, 26(10): 1182-1186. doi: 復制

1.	1 韓曉鵬, 紀斌平. 前交叉韌帶重建技術的進展. 國際骨科學雜志, 2008, 29(3): 173-176. 2 李健, 董大翠, 余世勇, 等. 股骨髁間窩的應用解剖及其臨床研究. 中華實驗外科雜志, 2001, 18(2): 140-141.
2.	Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy, 1995, 11(3): 312-321.
3.	Pape D, Seil R, Adam F, et al. Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome? Arch Orthop Trauma Surg, 2001, 121(10): 574-577.
4.	LaPrade RF, Terry GC, Montgomery RD, et al. The effects of aggressive notchplasty on the normal knee in dogs. Am J Sports Med, 1998, 26(2): 193-200.
5.	Asahina S, Muneta T, Ezura Y, et al. Notchplasty in anterior cruciate ligament reconstruction: an experimental animal study? Arthroscopy, 2000, 16(2): 165-172.
6.	Souryal TO, Freemen TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med, 1993, 21(4): 535-539.
7.	Tillman MD, Smith KR, Bauer JA, et al. Differences in three intercondylar notch geometry indices between males and females: a cadaver study. Knee, 2002, 9(1): 41-46.
8.	Van Eck CF, Martins CA, Kopf S, et al. Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study. Arthroscopy, 2011, 27(2): 207-212.
9.	Osterhoff G, Löffler S, Steinke H, et al. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee, 2011, 18(2): 98-103.
10.	Shelbourne KD, Gray T, Benner RW, et al. Intercondylar notch width measurement differences between african american and white men and women with intact anterior cruciate ligament knees. Am J Sports Med, 2007, 35(8): 1304-1307.
11.	Simon RA, Everhart JS, Nagaraja HN, et al. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech, 2010, 43(9): 1702-1707.
12.	Kopf S, Musahl V, Tashman S, et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 213-219.
13.	Colvin AC, Shen W, Musahl V, et al. Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8): 956-963.
14.	Van de Velde SK, DeFrate LE, Gill TJ, et al. The effect of anterior cruciate ligament deficiency on the in vivo elongation of the medial and lateral collateral ligaments. Am J Sports Med, 2007, 35(2): 294-300.
15.	Suggs J, Wang C, Li G, et al. The effect of graft stiffness on knee joint biomechanics after ACL reconstruction-a 3D computational simulation. Clin Biomech (Bristol, Avon), 2003, 18(1): 35-43.
16.	Hirokawa S, Tsuruno R. Three-dimensional deformation and stress distribution in an analytical/computational model of the anterior cruciate ligament. J Biomech, 2000, 33(9): 1069-1077.
17.	Limbert G, Taylor M, Middleton J, et al. Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. J Biomech, 2004, 37(11): 1723-1731.
18.	胡巖君, 余斌, 蘇秀云, 等. 基于MRI、CT影像下膝關節及交叉韌帶重建可視化的初步應用研究. 中華創傷骨科雜志, 2007, 9(5): 469-472.
19.	許鵬, 李彥林, 陳文棟, 等. MRI影像下股骨髁間窩三維數字化解剖學數據與實體解剖測量值的差異. 中國組織工程研究與臨床康復, 2011, 15(43): 8006-8009.

1. 1 韓曉鵬, 紀斌平. 前交叉韌帶重建技術的進展. 國際骨科學雜志, 2008, 29(3): 173-176. 2 李健, 董大翠, 余世勇, 等. 股骨髁間窩的應用解剖及其臨床研究. 中華實驗外科雜志, 2001, 18(2): 140-141.
2. Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy, 1995, 11(3): 312-321.
3. Pape D, Seil R, Adam F, et al. Blood loss in anterior cruciate ligament (ACL) reconstruction with and without intercondylar notchplasty: does it affect the clinical outcome? Arch Orthop Trauma Surg, 2001, 121(10): 574-577.
4. LaPrade RF, Terry GC, Montgomery RD, et al. The effects of aggressive notchplasty on the normal knee in dogs. Am J Sports Med, 1998, 26(2): 193-200.
5. Asahina S, Muneta T, Ezura Y, et al. Notchplasty in anterior cruciate ligament reconstruction: an experimental animal study? Arthroscopy, 2000, 16(2): 165-172.
6. Souryal TO, Freemen TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med, 1993, 21(4): 535-539.
7. Tillman MD, Smith KR, Bauer JA, et al. Differences in three intercondylar notch geometry indices between males and females: a cadaver study. Knee, 2002, 9(1): 41-46.
8. Van Eck CF, Martins CA, Kopf S, et al. Correlation between the 2-dimensional notch width and the 3-dimensional notch volume: a cadaveric study. Arthroscopy, 2011, 27(2): 207-212.
9. Osterhoff G, Löffler S, Steinke H, et al. Comparative anatomical measurements of osseous structures in the ovine and human knee. Knee, 2011, 18(2): 98-103.
10. Shelbourne KD, Gray T, Benner RW, et al. Intercondylar notch width measurement differences between african american and white men and women with intact anterior cruciate ligament knees. Am J Sports Med, 2007, 35(8): 1304-1307.
11. Simon RA, Everhart JS, Nagaraja HN, et al. A case-control study of anterior cruciate ligament volume, tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees. J Biomech, 2010, 43(9): 1702-1707.
12. Kopf S, Musahl V, Tashman S, et al. A systematic review of the femoral origin and tibial insertion morphology of the ACL. Knee Surg Sports Traumatol Arthrosc, 2009, 17(3): 213-219.
13. Colvin AC, Shen W, Musahl V, et al. Avoiding pitfalls in anatomic ACL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2009, 17(8): 956-963.
14. Van de Velde SK, DeFrate LE, Gill TJ, et al. The effect of anterior cruciate ligament deficiency on the in vivo elongation of the medial and lateral collateral ligaments. Am J Sports Med, 2007, 35(2): 294-300.
15. Suggs J, Wang C, Li G, et al. The effect of graft stiffness on knee joint biomechanics after ACL reconstruction-a 3D computational simulation. Clin Biomech (Bristol, Avon), 2003, 18(1): 35-43.
16. Hirokawa S, Tsuruno R. Three-dimensional deformation and stress distribution in an analytical/computational model of the anterior cruciate ligament. J Biomech, 2000, 33(9): 1069-1077.
17. Limbert G, Taylor M, Middleton J, et al. Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. J Biomech, 2004, 37(11): 1723-1731.
18. 胡巖君, 余斌, 蘇秀云, 等. 基于MRI、CT影像下膝關節及交叉韌帶重建可視化的初步應用研究. 中華創傷骨科雜志, 2007, 9(5): 469-472.
19. 許鵬, 李彥林, 陳文棟, 等. MRI影像下股骨髁間窩三維數字化解剖學數據與實體解剖測量值的差異. 中國組織工程研究與臨床康復, 2011, 15(43): 8006-8009.

《中國修復重建外科雜志》

基于MRI二維影像下股骨髁間窩的三維可視化研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

《中國修復重建外科雜志》

基于MRI二維影像下股骨髁間窩的三維可視化研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料