前交叉韧带重建后正常移植物及并发症的磁共振影像表现
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南京医科大学第一附属医院放射科

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国家自然科学基金(81701652)


Magnetic resonance imaging of normal grafts and complications after anterior cruciate ligament reconstruction
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Department of Radiology,the First Affiliated Hospital of Nanjing Medical University

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    摘要:

    目的:回顾前交叉韧带重建术后正常移植物不同时期信号特点及并发症的磁共振影像学表现。方法:对299例因前交叉韧带重建复查而行磁共振检查的患者的影像学资料进行回顾,根据移植物并发症在磁共振上的不同表现进行分类,描述其在T1和T2上的信号表现,并与其临床症状相结合。结果:在299例患者中,可以观察到不同时期移植物T2上的高信号,其中在术后4-6个月信号最高,之后逐渐降低。有66人(22.10%)出现了移植后的并发症,其中有5人(1.67%)胫骨隧道前移,有1人(0.33%)的胫骨隧道位置稍偏后。有16人(5.35%)出现了Cyclops,10人(3.34%)发生了移植物的再次断裂,有1人(0.33%)出现了术后的感染。有33人(11.04%)在术后不同时间内出现移植物隧道内的囊性灶,其中单纯发生在股骨隧道者3人,单纯发生在胫骨隧道者27人,胫骨及股骨隧道都存在者2人(其中一人为双束重建)。胫股隧道内的囊性信号最早发生于术后的5个月。有1人于术后3年的T2WI上发现了股骨段的少许囊性灶,但在再次间隔一年后的MRI复查中发现股骨段囊性灶未见明显显示。在胫骨隧道前移的患者中有2人同时出现了移植物的再次断裂和Cyclops。结论:磁共振作为行前交叉韧带重建后患者术后复查的一种主要方式而一直发挥着重要的作用,它能清晰的反映出移植物在不同阶段的变化,并评估移植物隧道位置是否恰当、是否出现关节内的纤维化、移植物是否发生再次断裂的不良事件、隧道内是否出现囊性灶以及术后是否发生了感染,起到早发现早提示的作用,以便于临床医生早期采取干预措施,提高患者的术后生活质量。

    Abstract:

    Objective: This study aims to review the magnetic resonance imaging of normal grafts with different periods of signal characteristics and complications after anterior cruciate ligament reconstruction. Methods: The imaging data of 299 patients who underwent MRI for reexamination after the ACLR were reviewed, classified according to the different manifestations of graft complications on MRI, described their signal on T1 and T2, and combined with their clinical symptoms. Results: In 299 patients, a high signal on the T2 of the graft could be observed at different times. Signal was highest at 4-6 months postoperatively and gradually decreased thereafter. Post-transplantation complications were observed in 66 (22.10%), of which 5 (1.67%) had an anterior displacement of the tibial tunnel and 1 (0.33%) had a slightly posterior position of the tibial tunnel. Cyclops was seen in 16 (5.35%), re-rupture of the graft occurred in 10 (3.34%), and one (0.33%) had a postoperative infection. Cystic signal in the tunnel were present in 33 (11.04%) at various times postoperatively, including 3 in the femoral tunnel alone, 27 in the tibiofemoral tunnel alone, and 2 in both tibiofemoral and femoral tunnels (one of which was a double bundle reconstruction). Cystic signals in the tibiofemoral tunnel occurred as early as 5 months postoperatively. One person had a few cystic signal in the femoral tunnel on T2WI after 3 years of the operation, but on MRI review at a further interval of one year ,it was not significantly demonstrated. There are two patients who underlying anterior displacement of the tibial tunnel had both re-rupture and Cyclops of the graft.

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  • 收稿日期:2023-08-04
  • 最后修改日期:2023-11-03
  • 录用日期:2024-02-27
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