膝关节解剖学参数与非接触性前交叉韧带损伤的相关性之倾向评分匹配研究

doi:10.13418/j.issn.1001-165x.2019.06.015

摘要/Abstract

摘要： 目的　采用倾向评分匹配研究膝关节解剖学参数与非接触性前交叉韧带（anterior cruciate ligament，ACL）损伤的相关性。方法　选取2013年7月~2018年7月就诊我院的单侧非接触性ACL损伤患者（Nc-ACL group）；对照组是可疑膝关节损伤，经MRI检查排除其骨及软组织解剖结构异常的患者。Nc-ACL组与对照组年龄、性别、身高、体重进行倾向评分匹配。在MIR上测量膝关节解剖学参数：髁间窝指数（NWI）、髁间窝形态指数（NSI）、内侧胫骨平台坡度（MTS）、外侧胫骨平台坡度（LTS）、胫骨解剖轴-髌腱轴夹角（PTTSA）。结果　Nc-ACL组入组136例，共136膝。对照组，入组358例，共358膝。Nc-ACL组与对照组患者年龄、性别、身高、体重进行倾向评分匹配。按照1：1不取代的最近邻匹配法完成完成匹配，两组最终分别入组68例，均为68膝。Nc-ACL组患者NWI低于对照组且差异具有统计学意义（P<0.05）；Nc-ACL组患者LTS、MT、PTTSA均高于对照组且差异具有统计学意义（P<0.05）。Nc-ACL组患者中男/女亚组NWI均低于对照组中男/女亚组且差异具有统计学意义（P<0.05）；Nc-ACL组患者中男/女亚组LTS、MT、PTTSA均高于对照组中男/女亚组且差异具有统计学意义（P<0.05）。男性与女性NWI、NSI、LTS、MT、PTTSA各参数比较差异均无统计学意义（P>0.05）。NWI最佳截断值0.261，敏感度64.94%，特异度77.14%；LTS最佳截断值9.11，敏感度89.66%，特异度57.86%；MTS最佳截断值8.84，敏感度70.11%，特异度65.71%； PTTSA最佳截断值26.58，敏感度83.91%，特异度69.29%。结论　NWI、MTS、LTS、PTTSA的异常可能与非接触性ACL损伤具有密切联系。这一结论需要进一步大样本来证实。

关键词: 膝关节, 　前交叉韧带, 　解剖学参数, 　损伤, 　性别

Abstract: Objective　To study the correlation between the anatomical parameters of knee joint and non-contact anterior cruciate ligament injury by propensity score matching.　Methods　Unilateral non-contact ACL injury patients (Nc-ACL group) who were treated in our hospital from July 2013 to July 2018 were selected. The control group was the patients who having knee joint injuries examined by MRI, but no abnormal anatomical structure of bone and soft tissue. The Nc-ACL group and the control group went propensity score matching in terms of age, gender, height and weight. Anatomical parameters of knee joint were measured on MIR: notch width index (NWI), notch shape index (NSI), lateral tibial plateau slope (LTS), medial tibial plateau slope (MTS), patellar tendon-tibial shaft angle (PTTSA).　Results　Total of 136 cases (136 knees) were enrolled in Nc-ACL group. In the control group, 358 cases (358 knees) were enrolled. The Nc-ACL group and the control group went propensity score matching in terms of age, gender, height and weight. The matching was completed with the method of same size ratio non-substituted nearest neighbor. The two groups were enrolled respectively into 68 cases (68 knees). NWI with statistical difference in Nc-ACL group was lower than that in control group (P<0.05). LTS, MT and PTTSA with statistical difference in Nc-ACL group were higher than those in control group (P<0.05). The NWI of male/female subgroup with statistical difference in Nc-ACL group was lower than that of male/female subgroup in control group (P<0.05). LTS, MT and PTTSA of male/female subgroup with statistical difference in Nc-ACL group were higher than those of male/female subgroup in control group (P<0.05). There was no statistical difference in the parameters of NWI, NSI, LTS, MT and PTTSA between male and female (P>0.05). The best truncation value of NWI was 0.261, sensitivity 64.94%, specificity 77.14%; LTS 9.11, sensitivity 89.66%, specificity 57.86%; MTS 8.84, sensitivity 70.11%, specificity 65.71%; PTTSA was 26.58, sensitivity 83.91%, specificity was 69.29%.　Conclusions　The abnormalities of NWI, MTS, LTS and PTTSA may be closely related to non-contact ACL injury. However, this conclusion needs more samples to be confirmed.

Key words: Knee joint;　Anterior cruciate ligament;　Anatomical parameters, 　Injury, 　Gender

中图分类号:

R322.72

何敏, 贾芝和, 刘水红, 文毅英, 高志增. 膝关节解剖学参数与非接触性前交叉韧带损伤的相关性之倾向评分匹配研究[J]. 中国临床解剖学杂志, 2019, 37(6): 686-690.

HE Min, JIA Zhi-he, LIU Shui-hong, WEN Yi-ying, GAO Zhi-zeng. Propensity score matching study of correlation between anatomical parameters of knee joint and non-contact anterior cruciate ligament (ACL) injury[J]. Chinese Journal of Clinical Anatomy, 2019, 37(6): 686-690.

参考文献 15

[1]	Dai B, Mao D, Garrett WE, et al. Anterior cruciate ligament injuries in soccer: Loading mechanisms, risk factors, and prevention programs[J]. Journal of Sport and Health Science, 2014, 3(4): 299-306.
[2]	Dragoo JL, Castillo TN, Braun HJ, et al. Prospective correlation between serum relaxin concentration and anterior cruciate ligament tears among elite collegiate female athletes[J]. Am J Sports Med, 2011, 39(10): 2175-2180.
[3]	Wetters N, Weber AE, Wuerz TH, et al. Mechanism of injury and risk factors for anterior cruciate ligament injury[J]. Operative Techniques in Sports Medicine, 2016, 24(1): 2-6.
[4]	Alentorn-Geli E, Pelfort X, Mingo F, et al. An evaluation of the association between radiographic intercondylar notch narrowing and anterior cruciate ligament injury in men: the notch angle is a better parameter than notch width[J]. Arthroscopy, 2015, 31(10): 2004-2013.
[5]	李豪, 吴震宇, 王大麟. 股骨髁间窝及胫骨平台后倾角的MRI测量与前交叉韧带损伤的相关性研究[J]. 中国骨与关节损伤杂志, 2017, 32(6): 585-588.
[6]	Englander ZA, Cutcliffe HC, Utturkar GM, et al. In vivo assessment of the interaction of patellar tendon tibial shaft angle and anterior cruciate ligament elongation during flexion[J]. J Biomech, 2019, 90(11): 123-127.
[7]	Hoteya K, Kato Y, Motojima S, et al. Association between intercondylar notch narrowing and bilateral anterior cruciate ligamentinjuries in athletes[J]. Arch Orthop Trauma Surg, 2011, 131(3): 371-376.
[8]	Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes[J]. Am J Sports Med, 1993, 21(4): 535-539.
[9]	Domzalski M, Grzelak P, Gabos P. Risk factors for anterior cruciate ligament injury in skeletally immature patients: analysis of intercondylar notch width using magnetic resonance imaging[J]. Int Orthop, 2010, 34(5): 703-707.
[10]	Webb JM, Salmon LJ, Leclerc E, et al. Posterior tibial slope and further anterior cruciate ligament injuries in the anterior cruciate ligament-reconstructed patient[J]. Am J Sports Med, 2013, 41(12): 2800-2804.
[11]	Jaecker V, Drouven S, Naendrup JH, et al. Increased medial and lateral tibial posterior slopes are independent risk factors for graft failure following ACL reconstruction[J]. Arch Orthop Trauma Surg, 2018, 138(10): 1423-1431.
[12]	DeMorat G, Weinhold P, Blackburn T, et al. Aggressive quadriceps loading can induce noncontact anterior cruciate ligament injury[J]. Am J Sports Med, 2004, 32(2): 477-483.
[13]	Beynnon BD, Hall JS, Sturnick DR, et al. Increased slope of the lateral tibial plateau subchondral bone is associated with greater risk of noncontact ACL injury in females but not in males: a prospective cohort study with a nested, matched case-control analysis[J]. Am J Sports Med, 2014, 42(5): 1039-1048.
[14]	Uhorchak JM, Scoville CR, Williams GN, et al. Risk factors associated with noncontact injury of the anterior cruciate ligament: a prospective four-year evaluation of 859 West Point cadets[J]. Am J Sports Med, 2003, 31(6): 831-842.
[15]	K S, Chamala T, Kumar A. Comparison of anatomical risk factors for noncontact anterior cruciate ligament injury using magnetic resonance imaging[J]. J Clin Orthop Trauma, 2019, 10(1): 143-148.