Terauchi Ryu, Arai Yuji, Hara Kunio, Minami Ginjiro, Nakagawa Shuji, Takahashi Takeshi, Ikoma Kazuya, Ueshima Keiichiro, Shirai Toshiharu, Fujiwara Hiroyoshi, Kubo Toshikazu
Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Department of Orthopaedics, Social Insurance Kyoto Hospital, Kyoto, Japan.
Knee Surg Sports Traumatol Arthrosc. 2016 Jan;24(1):169-75. doi: 10.1007/s00167-014-3358-x. Epub 2014 Oct 7.
In this study, magnetic resonance angiography (MRA) was performed in the early phase after anterior cruciate ligament (ACL) reconstruction to analyse the changes in nutrient blood vessels and blood flow to the femoral and tibial tunnels and the intraosseous tendon grafts.
The subjects were 30 patients who underwent single-bundle ACL reconstruction with an autogenous hamstring tendon. MRA was performed at 2, 3, and 6 months postoperatively (n = 10 at each time point). The mean overall signal-to-noise ratios (SNRs) in the tunnel regions and in the region of the tendon graft were compared in each femur and tibia.
Blood vessels from arteries reached the femoral and tibial tunnels 2 months postoperatively. The tunnel walls showed high signal intensity, while the intraosseous tendon grafts had lower intensity. SNRs showed significant differences between the femoral and tibial tunnels overall and the intraosseous tendon grafts. At 3 and 6 months postoperatively, the signal intensity of the tunnel walls was decreased significantly, while that of the intraosseous tendon grafts was also decreased, but not significantly. At these times, the SNRs of the femoral and tibial tunnels did not differ significantly, both overall and in the region of the intraosseous tendon grafts.
Revascularization around the femoral and tibial tunnels occurred at 2 months postoperatively, with blood flow subsequently decreasing over time until 6 months. This revascularization may be involved in bone tendon healing and maturation of the tendon graft within the bone tunnels. Evaluations of revascularization by MRA may show the maturation stage of the graft and guide medical rehabilitation.
IV.
在本研究中，对前交叉韧带（ACL）重建术后早期进行磁共振血管造影（MRA），以分析股骨和胫骨隧道以及骨内肌腱移植物的滋养血管变化和血流情况。
研究对象为30例行自体腘绳肌腱单束ACL重建的患者。术后2个月、3个月和6个月进行MRA检查（每个时间点n = 10）。比较每侧股骨和胫骨隧道区域以及肌腱移植物区域的平均总体信噪比（SNR）。
术后2个月动脉血管到达股骨和胫骨隧道。隧道壁显示高信号强度，而骨内肌腱移植物信号强度较低。股骨和胫骨隧道总体与骨内肌腱移植物之间的SNR存在显著差异。术后3个月和6个月，隧道壁信号强度显著降低，骨内肌腱移植物信号强度也降低，但不显著。此时，股骨和胫骨隧道的SNR在总体和骨内肌腱移植物区域均无显著差异。
股骨和胫骨隧道周围在术后2个月发生血管再生，随后血流随时间减少直至6个月。这种血管再生可能参与骨腱愈合以及骨隧道内肌腱移植物的成熟。通过MRA评估血管再生情况可显示移植物的成熟阶段并指导医学康复。
IV级。
