摘要
目的 探讨不同屈曲角度下膝关节前外侧韧带(ALL)的磁共振成像(MRI)解剖学特征。方法 选取正常膝关节志愿者67例,对膝关节按标准冠状位与斜冠状位、0°~60°屈曲、大/小角度屈曲分别行1.5T MRI扫描,观察ALL解剖学特征及其在不同屈曲角度下的变化。选取1例冷冻右膝关节标本行15°屈曲斜冠状位扫描,解剖分离出ALL,标记后按MRI斜冠状位扫描方向切片,验证MRI中所见的解剖结构是否实际存在。结果 标准冠状位与斜冠状位MRI表现:斜冠状位时,ALL股骨段(P=0.008)、半月板段(P<0.001)及胫骨段(P=0.031)显示率更佳,同层显示部位数目更多,差异有统计学意义(P<0.001)。0°~60°屈曲MRI表现:0°~15°时股骨段显示率更佳,60°胫骨段显示率更佳,随屈曲角度增大,股骨段显示率降低、胫骨段显示率升高,0°~15°时同层显示部位数目更多,差异有统计学意义(P<0.02);随屈曲角度增大,ALL下段长度变短(F=13.25,P=0.002,偏η^(2)=0.41)。大/小角度屈曲MRI表现:大角度屈曲时,胫骨段显示率更佳(P=0.003)、胫骨段与髂胫束(ITB)间距增大(Z=-5.65,P<0.001),同时股骨段(Z=-3.64,P<0.001)、下段(Z=-3.23,P<0.05)、关节面水平宽度(Z=-4.27,P<0.001)变短,关节面水平厚度(Z=-5.08,P<0.001)增大,ALL更松弛。62例中ALL与外侧半月板(LM)紧密连接型占比最高[56.5%(35/62)],胫骨段与LM-胫骨韧带存在解剖间隔例数占比最高[77.4%(48/62)];在MRI中可以ITB、外侧副韧带、ALL胫骨端滋养动脉、膝下外侧动脉及其上返支为参考标志,对ALL进行辨别。ALL及邻近解剖结构与冷冻标本MRI、大体解剖及切片中的观察结果一致。结论 MRI中ALL具有明确可辨的解剖结构,与邻近结构具有相对稳定的空间位置关系,并在屈膝运动中发生规律性变化,ALL整体形态小角度屈曲更紧张,大角度屈曲更松弛。
Objective To investigate the magnetic resonance imaging(MRI)anatomical features of the anterolateral ligament(ALL)of the knee under different flexion angles.Methods Sixty-seven volunteers with normal knee joints were enrolled in this study.The knee joints were scanned with 1.5T MRI in the standard coronal and oblique coronal,0°-60°flexion,and large/small flexion angles,to observe the anatomical features of the ALL and its changes under different flexion angles,respectively.In order to verify the existence of anatomical structures in MRI,a frozen right knee joint specimen was selected for 15°flexion oblique coronal scan,dissected,isolated ALL,labeled and sectioned according to the oblique coronal scanning direction of MRI.Results The MRI performance in standard and oblique coronal position was as follows:in oblique coronal position,the femoral segment(P=0.008),meniscus segment(P<0.001)and tibial segment(P=0.031)were better displayed,and the number of ALL sites was more in the same layer(P<0.001).The MRI performance of 0°-60°flexion was as follows:the display rate of the femoral segment was better at 15°,and that of the tibial segment was better at 60°.As the flexion angle increased,the display rate of the femoral segment decreased and that of the tibial segment increased;more sites were displayed in the same layer of ALL at 0°-15°(P<0.002);and the length of the inferior segment of the ALL became shorter as the angle of flexion increased(F=13.25,P=0.002,partialη2=0.41).Large/small flexion angle MRI manifestations was as follows:In large flexion angle,the tibial segment display rate was higher(P=0.003),the distance between the tibial segment and iliotibial band(ITB)was increased(Z=-5.65,P<0.001),while the femoral segment(Z=-3.64,P<0.001),the inferior segment(Z=-3.23,P<0.05),and articular surface level width(Z=-4.27,P<0.001)became shorter,the thickness of ALL at the articular surface level(Z=-5.08,P<0.001)increased,and the ALL became more relaxed.Among the 62 cases,the proportion of tight connection type between ALL and lateral meniscus(LM)was the highest[56.5%(35/62)],and the proportion of anatomical interval between tibial segment and LM-tibial ligament was the highest[77.4%(48/62)].In MRI,ITB,lateral collateral ligament,nutrient arteries around the tibial attachment of ALL,lateral inferior genicular artery and its upward reentry branch can be used as reference markers to distinguish ALL.The MR manifestations of ALL and adjacent anatomical structures seen in this study were consistent with the observations in MRI,gross anatomy and section of the frozen specimen.Conclusions In MRI,the ALL has a clearly recognizable anatomical structure,has a relatively stable spatial positional relationship with adjacent structures,and undergoes regular changes in knee flexion movements,with the overall morphology of the ALL being more tense in small-angle flexion and more relaxed in large-angle flexion.
作者
纪文策
娄晶
王珊珊
梁友
王光彬
JI Wence;LOU Jing;WANG Shanshan;LIANG You;WANG Guangbin(Cheeloo College of Medicine,Shandong University,Jinan 250012,China;Department of Radiology,Guang'an men Hospital of the Chinese Academy of Traditional Chinese Medicine,Jinan Hospital(Ji-nan Municipal Hospital of Traditional Chinese Medicine),Jinan 250012,China;Department of Orthopedics,Guang'an men Hospital of the Chinese Academy of Traditional Chinese Medicine,Jinan Hospital(Jinan Municipal Hospital of Traditional Chinese Medicine),Jinan 250012,China;Department of radiology,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)
出处
《医学影像学杂志》
2025年第7期141-148,共8页
Journal of Medical Imaging
基金
山东省山东大学卫健委科技发展计划项目(编号:2024309006)。
关键词
膝关节
磁共振成像
解剖
前外侧韧带
Knee
Magnetic resonance imaging
Anatomy
Anterolateral ligament
