术前超声检查在预测前交叉韧带重建中腘绳肌腱移植物直径方面不可靠。
Preoperative Ultrasonography Is Unreliable in Predicting Hamstring Tendon Graft Diameter for ACL Reconstruction.
作者信息
Momaya Amit M, Beicker Clint, Siffri Paul, Kissenberth Michael J, Backes Jeffrey, Bailey Lane, Rulewicz Gabriel J, Mercuri Jennifer M, Shealy E Carlisle, Tokish John M, Thigpen Charles A
机构信息
Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA.
Texas Hill Country Orthopaedics and Sports Medicine, Fredericksburg, Texas, USA.
出版信息
Orthop J Sports Med. 2018 Jan 3;6(1):2325967117746146. doi: 10.1177/2325967117746146. eCollection 2018 Jan.
BACKGROUND
Hamstring autograft size <8 mm has been shown to be a predictor for failure after anterior cruciate ligament (ACL) reconstruction. The ability to predict graft size preoperatively is helpful in counseling patients about the possible need for graft augmentation.
PURPOSE
To determine whether preoperative ultrasound (US) measurements of hamstring tendons can predict intraoperative graft diameter during ACL reconstruction.
STUDY DESIGN
Cohort study (diagnosis); Level of evidence, 2.
METHODS
Twenty patients undergoing unilateral isolated ACL reconstruction were prospectively enrolled in the study (10 males, 10 females; mean ± SD age, 22.8 ± 6.6 years; height, 175.1 ± 7.1 cm; weight, 81.4 ± 14.2 kg; body mass index, 26.5 ± 4.1 kg/m). Hamstrings were assessed by US, and double-looped semitendinosus-gracilis hamstring size was independently calculated with a freehand selection method on a nonmagnified US image by 2 orthopaedic surgeons. Intraoperative autograft size was determined with a standard graft-sizing tool. Intra- and interrater reliability was measured with intraclass correlation coefficients (ICCs) and standard error of the measure (SEM). A receiver operating characteristic curve was calculated to assess the ability of the US measurement to predict intraoperative measurements.
RESULTS
The mean autograft diameter by US was 8.9 ± 0.98 mm, while the mean intraoperative hamstring graft size was 8.1 ± 0.89 mm. There was excellent intrarater (ICC = 0.95, SEM = 0.32 mm) and interrater (ICC = 0.88, SEM = 0.55 mm) reliability for US measurements. Receiver operating characteristic analysis showed that US did not consistently quantify graft size. Graft size did not significantly correlate with height, weight, or body mass index in our sample ( > .05).
CONCLUSION
These results suggest that preoperative US imaging of the hamstring tendons is unreliable in predicting intraoperative graft diameter.
背景
已表明腘绳肌自体移植物尺寸小于8 mm是前交叉韧带（ACL）重建术后失败的一个预测指标。术前预测移植物尺寸的能力有助于向患者咨询是否可能需要增加移植物。
目的
确定术前超声（US）测量腘绳肌腱是否能预测ACL重建术中移植物直径。
研究设计
队列研究（诊断）；证据等级，2级。
方法
前瞻性纳入20例接受单侧孤立ACL重建的患者（10例男性，10例女性；平均±标准差年龄，22.8±6.6岁；身高，175.1±7.1 cm；体重，81.4±14.2 kg；体重指数，26.5±4.1 kg/m）。通过超声评估腘绳肌，由2名骨科医生在未放大的超声图像上采用徒手选择法独立计算双环半腱肌-股薄肌腘绳肌尺寸。术中自体移植物尺寸用标准移植物测量工具确定。用组内相关系数（ICC）和测量标准误差（SEM）测量评分者内和评分者间的可靠性。计算受试者工作特征曲线以评估超声测量预测术中测量值的能力。
结果
超声测量的自体移植物平均直径为8.9±0.98 mm，而术中腘绳肌移植物平均尺寸为8.1±0.89 mm。超声测量具有出色的评分者内（ICC = 0.95，SEM = 0.32 mm）和评分者间（ICC = 0.88，SEM = 0.55 mm）可靠性。受试者工作特征分析表明，超声不能始终如一地量化移植物尺寸。在我们的样本中，移植物尺寸与身高、体重或体重指数无显著相关性（P>0.05）。
结论
这些结果表明，术前对腘绳肌腱进行超声成像在预测术中移植物直径方面不可靠。
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