核磁共振测量下健康股骨髁间窝的形态学指标分析

doi:10.3877/cma.j.issn.1674-134X.2018.01.011

目的

探讨健康髁间窝形态学指标在不同性别、不同髁间窝类型间的差异及与年龄的关系，为髁间窝形态相关疾病发病机制的阐明提供依据。

方法

对351例(男166例，182膝，女154例，169膝)行膝关节MRI检查未见明显异常(无交叉韧带损伤等疾病)的成年人进行轴位及冠状位测量、计算各形态学指标(冠状位及轴位宽度指数、形态指数、髁间窝容积)，依轴位形态对髁间窝分型，并分析各指标与年龄的相关性。数据分析采用SPSS 20.0统计软件进行，两个均值的比较用两独立样本t检验；多个均值的比较用单因素方差分析，率的比较用卡方检验。

结果

对200例膝进行分型(余151例未找到合适的分型层面)，其中A型112例，占56%，U型83例，占41.5%，W型5例，占2.5%，不同性别间各型比例无统计学差异(χ²＝2.751，P>0.05)；无论轴位还是冠状位髁间窝宽度指数及形态指数在不同性别间无差异，在不同髁间窝形态间差异有统计学意义(F＝3.435，P<0.05；F＝8.497，P<0.01)；髁间窝容积在不同性别(CSA1：t＝3.311，P<0.01；CSA2：t＝3.267，P<0.01)及不同形态间差异均有统计学意义(F＝7.635，P<0.01；F＝4.531，P<0.05)；髁间窝容积在青年组最大、中年组次之、老年组最小(F＝5.346，P<0.05)。

结论

不同性别间髁间窝宽度指数及形态指数无差异，但髁间窝容积男性显著大于女性；A型髁间窝在3型中最为狭窄；随年龄增长髁间窝有逐渐变小的趋势。

关键词: 磁共振成像, 股骨, 骨和骨组织, 分类法

Objective

To investigate the difference of morphological indexes of healthy intercondylar notch between different genders and different types of intercondylar notch and their relationship with age, and to provide evidence of the elucidation of the pathogenesis of intercondylar notch related diseases.

Methods

A total of 351 healthy adult knees (182 knees of 166 males and 169 knees of 154 females) were performed axial and coronal MRI examination and morphological measurements were taken. The indexes were calculated, the types were classified and the relationships between these indexes and age were analyzed. All the data were analyzed using t test, one-way ANOVA and chi-square test by SPSS 20.0.

Results

Two hundred knees were divided into three types(the other 151 cases could not find the right slice to classify): type A(112 knees, 56%), type U(83 knees, 41.5%), type W(five knees, 2.5%), and there was no significance of the percentages of three types between males and females(χ²=2.751, P=0.253). The notch width index(NWI) and notch shape index(NSI) of both axial and coronal slices had no significant difference between genders, while there were significant differences among the three intercondylar notch types (F=3.435, P<0.05; F=8.497, P<0.01). The volume of the notch had significant difference both between different genders(CSA1: t=3.311, P<0.01; CSA2: t=3.267, P<0.01) and among different types(F=7.635, P<0.01; F=4.531, P<0.05). The volumes of the young age group was the largest while the elder group were the smallest(F=5.346, P=0.024).

Conclusions

Among the three types, type A is the narrowest. NWI and NSI show no significant difference between genders, while volume of man is larger than woman. The intercondylar notch tends to be narrower as age increases.

Key words: Magnetic resonance imaging, Femur, Bone and bones, Classification

图1 髁间窝的A/U/W分型^[3]图A 　示A型，较深，顶部较锐利，开口处较窄；图B 　示U型，顶部较圆润、开口处无明显狭窄；图C　示W型，双顶型

图2 轴位及冠状位髁间窝宽度、深度及股骨髁宽度的测量。图A 　为轴位测量：基准线为股骨内外髁软骨的切线，深度为髁间窝顶至基准线的距离，髁间窝宽度及股骨髁宽度均为深度1/2处髁间窝和股骨髁的宽度；图B 　为冠状位测量：基准线为股骨内外髁软骨的切线，深度为髁间窝顶至基准线的距离，髁间窝宽度及股骨髁宽度均为髁间窝出口最窄处髁间窝和股骨髁的宽度

图3 NWIA和NWIP的测量。图A NWIA(髁间窝宽度指数-A)：冠状位紧邻PCL胫骨止点层面其前的层面；图B NWIP(髁间窝宽度指数-P)：冠状位恰好包含PCL胫骨止点的层面

表1 不同性别间各指标比较

?	男性		女性
?	(±s)	95%CI	(±s)	95%CI
NWI1	0.31±0.03	(0.30，0.31)	0.31±0.03	(0.30，0.31)
NSI1	0.66±0.08	(0.65，0.68)	0.66±0.11	(0.63，0.68)
CSA1	734.31±113.01^a	(712.65，755.97)	575.12±79.75^a	(557.71，592.54)
NWI2	0.24±0.04	(0.23，0.24)	0.25±0.04	(0.24，0.25)
NSI2	0.71±0.12	(0.69，0.73)	0.70±0.11	(0.68，0.71)
CSA2	418.57±117.25^b	(400.92，436.22)	357.27±95.11^b	(342.47，372.07)
NWIA	0.27±0.03	(0.27，0.28)	0.28±0.04	(0.27，0.28)
NWIP	0.29±0.04	(0.28，0.29)	0.29±0.04	(0.28，0.29)

表1 不同性别间各指标比较

?	男性		女性
?	(±s)	95%CI	(±s)	95%CI
NWI1	0.31±0.03	(0.30，0.31)	0.31±0.03	(0.30，0.31)
NSI1	0.66±0.08	(0.65，0.68)	0.66±0.11	(0.63，0.68)
CSA1	734.31±113.01^a	(712.65，755.97)	575.12±79.75^a	(557.71，592.54)
NWI2	0.24±0.04	(0.23，0.24)	0.25±0.04	(0.24，0.25)
NSI2	0.71±0.12	(0.69，0.73)	0.70±0.11	(0.68，0.71)
CSA2	418.57±117.25^b	(400.92，436.22)	357.27±95.11^b	(342.47，372.07)
NWIA	0.27±0.03	(0.27，0.28)	0.28±0.04	(0.27，0.28)
NWIP	0.29±0.04	(0.28，0.29)	0.29±0.04	(0.28，0.29)

表2 不同髁间窝形态间各指标比较

?	A型		U型		W型
?	(±s)	95%CI	(±s)	95%CI	(±s)	95%CI
NWI1	0.30±0.03	(0.30，0.31)	0.31±0.03^a	(0.30，0.32)	0.31±0.03^a	(0.26，0.36)
NSI1	0.64±0.08^b	(0.62，0.65)	0.68±0.09^b	(0.66，0.70)	0.80±0.23^b	(0.43，1.17)
CSA1	561.14±118.71^b	(538.39，583.89)	675.02±137.04^b	(644.32，705.71)	589.47±125.16^b	(360.32，758.62)
NWI2	0.24±0.04^b	(0.23，0.24)	0.25±0.04^b	(0.24，0.26)	0.30±0.03^b	(0.26，0.33)
NSI2	0.67±0.10^b	(0.65，0.69)	0.74±0.11^b	(0.71，0.76)	0.78±0.10^b	(0.65，0.91)
CSA2	390.91±102.38^b	(371.29，410.53)	422.87±114.35^b	(397.09，448.65)	513.41±82.34^b	(411.17，615.65)
NWIA	0.26±0.03	(0.26，0.27)	0.29±0.04^a	(0.28，0.30)	0.30±0.06^a	(0.23，0.37)
NWIP	0.27±0.04	(0.27，0.28)	0.30±0.04^a	(0.29，0.31)	0.29±0.06^a	(0.22，0.36)

表2 不同髁间窝形态间各指标比较

?	A型		U型		W型
?	(±s)	95%CI	(±s)	95%CI	(±s)	95%CI
NWI1	0.30±0.03	(0.30，0.31)	0.31±0.03^a	(0.30，0.32)	0.31±0.03^a	(0.26，0.36)
NSI1	0.64±0.08^b	(0.62，0.65)	0.68±0.09^b	(0.66，0.70)	0.80±0.23^b	(0.43，1.17)
CSA1	561.14±118.71^b	(538.39，583.89)	675.02±137.04^b	(644.32，705.71)	589.47±125.16^b	(360.32，758.62)
NWI2	0.24±0.04^b	(0.23，0.24)	0.25±0.04^b	(0.24，0.26)	0.30±0.03^b	(0.26，0.33)
NSI2	0.67±0.10^b	(0.65，0.69)	0.74±0.11^b	(0.71，0.76)	0.78±0.10^b	(0.65，0.91)
CSA2	390.91±102.38^b	(371.29，410.53)	422.87±114.35^b	(397.09，448.65)	513.41±82.34^b	(411.17，615.65)
NWIA	0.26±0.03	(0.26，0.27)	0.29±0.04^a	(0.28，0.30)	0.30±0.06^a	(0.23，0.37)
NWIP	0.27±0.04	(0.27，0.28)	0.30±0.04^a	(0.29，0.31)	0.29±0.06^a	(0.22，0.36)

表3 不同年龄段间各指标比较

?	青年组(18－29岁)		中年组(30－49岁)		老年组(50岁及以上)
?	(±s)	95%CI	(±s)	95%CI	(±s)	95%CI
NWI1	0.31±0.03	(0.30，0.31)	0.30±0.03	(0.30，0.31)	0.31±0.03	(0.30，0.32)
NSI1	0.66±0.11	(0.63，0.68)	0.66±0.09	(0.64，0.69)	0.66±0.06	(0.64，0.68)
CSA1	689.90±132.55	(660.41，719.40)	650.26±125.19^a	(621.06，679.47)	639.05±112.16^a	(601.65，676.44)
NWI2	0.24±0.04	(0.23，0.25)	0.24±0.05	(0.23，0.25)	0.25±0.04	(0.24，0.26)
NSI2	0.71±0.11	(0.69，，0.73)	0.70±0.12	(0.68，0.72)	0.70±0.11	(0.67，0.73)
CSA2	397.91±115.96^b	(377.38，418.44)	375.96±108.36^b	(358.77，393.16)	305.69±105.95^b	(276.49，334.90)
NWIA	0.28±0.04	(0.27，0.29)	0.27±0.04	(0.27，0.28)	0.27±0.03	(0.26，0.28)
NWIP	0.29±0.04	(0.29，0.30)	0.28±0.04^a	(0.28，，0.29)	0.27±0.03^a	(0.26，0.29)

表3 不同年龄段间各指标比较

?	青年组(18－29岁)		中年组(30－49岁)		老年组(50岁及以上)
?	(±s)	95%CI	(±s)	95%CI	(±s)	95%CI
NWI1	0.31±0.03	(0.30，0.31)	0.30±0.03	(0.30，0.31)	0.31±0.03	(0.30，0.32)
NSI1	0.66±0.11	(0.63，0.68)	0.66±0.09	(0.64，0.69)	0.66±0.06	(0.64，0.68)
CSA1	689.90±132.55	(660.41，719.40)	650.26±125.19^a	(621.06，679.47)	639.05±112.16^a	(601.65，676.44)
NWI2	0.24±0.04	(0.23，0.25)	0.24±0.05	(0.23，0.25)	0.25±0.04	(0.24，0.26)
NSI2	0.71±0.11	(0.69，，0.73)	0.70±0.12	(0.68，0.72)	0.70±0.11	(0.67，0.73)
CSA2	397.91±115.96^b	(377.38，418.44)	375.96±108.36^b	(358.77，393.16)	305.69±105.95^b	(276.49，334.90)
NWIA	0.28±0.04	(0.27，0.29)	0.27±0.04	(0.27，0.28)	0.27±0.03	(0.26，0.28)
NWIP	0.29±0.04	(0.29，0.30)	0.28±0.04^a	(0.28，，0.29)	0.27±0.03^a	(0.26，0.29)

[1]	Shelbourne KD,Kerr B. The relationship of femoral intercondylar notch width to height, weight, and sex in patients with intact anterior cruciate ligaments[J]. Am J Knee Surg, 2001, 14(2): 92-96.
[2]	Haim A,Pritsch T,Yosepov L, et al. Anterior cruciate ligament injuries[J]. Harefuah, 2006, 145(3): 244-245.
[3]	Al－Saeed O,Brown M,Athyal R, et al. Association of femoral intercondylar notch morphology, width index and the risk of anterior cruciate ligament injury[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(3): 678-682.
[4]	Van Eck CF,Martins CA,Lorenz SG, et al. Femoral intercondylar notch shape and dimensions in ACL－injured patients[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1239-1244.
[5]	李彦林,许鹏,韩睿, 等. 基于MRI二维影像下股骨髁间窝的三维可视化研究[J]. 中国修复重建外科杂志, 2012, 26(10): 1182-1186.
[6]	Domzalski M,Grzelak P,Gabos P. Risk factors for Anterior Cruciate Ligament injury in skeletally immature patients: analysis of intercondylar notch width using Magnetic Resonance Imaging[J]. Int Orthop, 2010, 34(5): 703-707.
[7]	Stein V,Li L,Guermazi A, et al. The relation of femoral notch stenosis to ACL tears in persons with knee osteoarthritis[J]. Osteoarthritis Cartilage, 2010, 18(2): 192-199.
[8]	Hoteya K,Kato Y,Motojima S, et al. Association between intercondylar notch narrowing and bilateral anterior cruciate ligament injuries in athletes[J]. Arch Orthop Trauma Surg, 2011, 131(3): 371-376.
[9]	Stijak L,Nikolić V,Blagojević Z, et al. Morphometric parameters of the intercondylar notch, gender and age differences[J]. Acta Chir Iugosl, 2009, 56(1): 53-59.
[10]	Tillman MD,Smith KR,Bauer JA, et al. Differences in three intercondylar notch geometry indices between males and females: a cadaver study[J]. Knee, 2002, 9(1): 41-46.
[11]	Swami VG,Mabee M,Hui C, et al. Three－dimensional intercondylar notch volumes in a skeletally immature pediatric population: a magnetic resonance imaging－based anatomic comparison of knees with torn and intact anterior cruciate ligaments[J]. Arthroscopy, 2013, 29(12): 1954-1962.
[12]	van Eck CF,Martins CA,Lorenz SG, et al. Assessment of correlation between knee notch width index and the three－dimensional notch volume[J]. Knee Surg Sports Traumatol Arthrosc, 2010, 18(9): 1239-1244.
[13]	Murshed KA,Ciçekcibaᶊi AE,Karabacakoğ A, et al. Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging[J]. Surg Radiol Anat, 2005, 27(2): 108-112.
[14]	Everhart JS,Flanigan DC,Chaudhari AM. Anteromedial ridging of the femoral intercondylar notch: an anatomic study of 170 archival skeletal specimens[J]. Knee Surg Sports Traumatol Arthrosc, 2014, 22(1): 80-87.
[15]	Zeng C,Gao SG,Wei J, et al. The influence of the intercondylar notch dimensions on injury of the anterior cruciate ligament: a meta－analysis[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(4): 804-815.
[16]	Dienst M,Schneider G,Altmeyer K, et al. Correlation of intercondylar notch cross sections to the ACL size: a high resolution Mr tomographic in vivo analysis[J]. Arch Orthop Trauma Surg, 2007, 127(4): 253-260.
[17]	Sutton KM,Bullock JM. Anterior cruciate ligament rupture: differences between males and females[J]. J Am Acad Orthop Surg, 2013, 21(1): 41-50.
[18]	Wada M,Tatsuo H,Baba H, et al. Femoral intercondylar notch measurements in osteoarthritic knees[J]. Rheumatology (Oxford), 1999, 38(6): 554-558.

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Morphological index analysis of healthy femoral intercondylar notch under MRI measurement

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Morphological index analysis of healthy femoral intercondylar notch under MRI measurement