| 江帆,沈蕾,骆祥伟,等.前交叉韧带全层撕裂病人磁共振成像多指标表现与行走功能障碍严重程度及术后功能恢复的相关性研究[J].安徽医药,2026,30(4):805-809. |
| 前交叉韧带全层撕裂病人磁共振成像多指标表现与行走功能障碍严重程度及术后功能恢复的相关性研究 |
| Correlation between multiple MRI indicators and the severity of gait dysfunction and postoperative functional recovery in patients with complete anterior cruciate ligament tears |
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| DOI：10.3969/j.issn.1009-6469.2026.04.033 |
| 中文关键词: 前交叉韧带损伤 磁共振成像(MRI) 半月板裸露征 行走功能障碍 功能恢复 |
| 英文关键词: Injury of anterior cruciate ligament Magnetic resonance imaging (MRI) Meniscal extrusion Gait dysfunction Functional recovery |
| 基金项目:蚌埠医科大学自然科学重点项目( 2024WJImxm06) |
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| 中文摘要: |
| 目的探讨前交叉韧带( ACL)全层撕裂病人的 MRI影像学异常表现与膝关节行走功能障碍严重程度及术后功能恢复的关系。方法回顾性纳入 103例 2019年 1月至 2024年 12月在中国人民解放军联勤保障部队第九〇一医院行关节镜检查确诊为单侧 ACL全层撕裂并完成术后 6个月随访的病人，收集其基本临床资料及术前膝关节磁共振成像( MRI)表现，包括 ACL信号中断、半月板后角裸露征、后交叉韧带( PCL)角度 /PCL指数异常、胫骨前移值异常等，记录并分析各 MRI异常项数。采用 Lysholm评分对术后功能分级，探讨不同 MRI异常指标、累积异常项数与行走功能障碍严重程度及术后康复的关系。通过多因素 logistic回归及受试者操作特征曲线( ROC曲线)分析评估预测模型的效能。结果共纳入 103例病人，其中 MRI以 ACL连续性中断最为常见［ 62.1%(64/103)］。单因素分析显示，术后 Lysholm评分疗效可靠组( n=68)的半月板裸露征发生率显著低于疗效不佳组( n=35)［10.3%(7/68)比 25.7%(9/35)P=0.038］。多因素 logistic回归分析显示，半月板裸露征( OR=4.65，P=0.029)及年龄 <65岁( OR=3.22，P=0.025)为术后功能恢复不，佳的独立危险因素。随着 MRI异常项数( 0或 1项， 2项， 3项及以上)的增加，术后功能恢复不佳发生率显著升高［分别为 18.5%(10/54)，47.4%(9/19)，53.3%(16/30)］，并呈线性趋势( P for trend=0.001)。 ROC曲线分析显示，基于上述独立危险因素构建的多因素模型对术后功能恢复不佳具有较好的预测能力( AUC=0.71)。结论 ACL全层撕裂病人中，半月板裸露征及 MRI多项异常的累积是行走功能障碍严重程度和术后功能恢复不良的重要风险预测指标。基于 MRI多指标的分级综合评估，有助于早期识别高危人群、优化个体化手术及康复方案，提升临床管理和功能恢复的精准性。 |
| 英文摘要: |
| Objective To explore the correlation between abnormal MRI findings and the severity of gait dysfunction as well as post-operative functional recovery in patients with complete anterior cruciate ligament (ACL) tears.Methods We retrospectively included103 patients who were arthroscopically confirmed to have unilateral complete ACL tear at 901 Hospital of the Joint Logistics SupportForce of The Chinese People's Liberation Army and completed 6 months of postoperative follow-up between January 2019 and Decem-ber 2024. Clinical data and preoperative knee MRI findings were collected, including ACL signal discontinuity, posterior horn of menis-cus extrusion, abnormal posterior cruciate ligament (PCL) angle/abnormal PCL index, and abnormal tibial anterior translation. The num-ber of abnormal MRI findings was recorded and analyzed. Postoperative functional recovery was evaluated using the Lysholm score.The association between different MRI abnormalities, cumulative number of abnormalities, and the severity of gait dysfunction as wellas postoperative recovery was explored. The predictive performance of the model was further assessed by multivariate logistic regres-sion and receiver operating characteristic curve (ROC curve).Results A total of 103 patients were included. The most common MRIfinding was ACL discontinuity [62.1% (64/103)]. Univariate analysis results showed that the incidence of meniscal extrusion was signifi-cantly higher in the poor outcome group (n=35) compared to the reliable outcome group (n=68) [25.7% (9/35) vs. 10.3% (7/68), P= 0.038]. Multivariate logistic regression results revealed that meniscal extrusion (OR=4.65, P=0.029) and age <65 years (OR=3.22, P= 0.025) were independent risk factors for poor postoperative functional recovery. As the number of abnormal MRI findings (0 or 1, 2,and ≥3) increased, the incidence of poor postoperative recovery rose significantly [18.5% (10/54), 47.4% (9/19), and 53.3% (16/30), re-spectively], showing a linear trend (P for trend=0.001). ROC curve analysis indicated that the multivariate model based on these inde-pendent risk factors had good predictive value for poor postoperative functional recovery (AUC=0.71). Conclusion In patients withcomplete ACL tear, meniscal extrusion and the accumulation of multiple abnormal MRI findings are important risk predictors for severegait dysfunction and poor postoperative functional recovery. Comprehensive evaluation based on multiple MRI indicators can facilitateearly identification of high-risk patients, optimize individualized surgical and rehabilitation strategies, and improve the accuracy of clin-ical management and functional recovery. |
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