單側直立側位膝關節X光攝影的Insall-Salvati index與青壯年前十字韌帶撕裂患者之相關性

The Correlation between the Insall-Salvati Index of the Lateral Standing Knee Joint X-ray and Young Adult Patients with Anterior Cruciate Ligament Tear

李子涵(Tzu-Han Li) ； 許敦韋(Tun-Wei Hsu)

《北市醫放雜誌》 10卷1期 (2020/12) Pp. 37-42

https://doi.org/10.6663/TPART.202012_10(1).0006

摘要

前十字韌帶撕裂傷為常見的重大膝關節傷害之一。當臨床上懷疑病患有前十字韌帶受傷時，會先安排基本影像X光檢查，但是對於韌帶的診斷無法提供有效幫助，因此須由後續的核磁共振檢查來進行診斷，由於其排檢時間過長，臨床無法很快排除前十字韌帶異常。因此本研究目的希望從觀察單側直立側位膝關節X光影像上，其髕骨高低測量值（Insall-Salvati index, IS index）是否可以推斷前十字韌帶損傷，為臨床早期診斷或治療方案的選擇提供理論依據。我們從影像系統和報告系統回溯性收集111位做過單側直立側位膝關節X光及後續核磁共振檢查報告為前十字韌帶撕裂病人，以及收集41位做過單側直立側位膝關節X光及有後續核磁共振檢查報告無異常病人，病患以青壯年為主（年齡為20至50歲），無膝關節手術並且X光擺位姿勢適當。IS index影像參數定量方式（髕骨肌腱（韌帶）長度／髕骨對角最長長度）由PACS影像系統在單側直立側位膝關節X光影像上做測量，並且應用SPSS 17.0統計工具進行數據分析，前十字韌帶撕裂組的IS數值平均明顯低於正常控制組（1.01 ± 0.15 vs 1.08 ± 0.15, p=0.01）。另外以性別分類分析，正常控制組的男性與女性IS index數值分別為（1.06 ± 0.13 vs 1.09 ± 0.16, p=0.555），前十字韌帶撕裂組的男性與女性IS index數值分別為（0.99 ± 0.14 vs 1.03 ± 0.15, p=0.167），皆顯示男性IS index數值較低。依據統計分析之結果，我們可以得到以下初步結論；在擺位正確且影像品質適當的單側直立側位膝關節X光影像上，以IS index的測量方式呈現低位髕骨時，可評估前十字韌帶撕裂的可能潛在發生機率，並提供臨床醫師另一個初步診斷的參考。

關鍵字

前十字韌帶 ； 膝關節X光影像 ； 髕骨高低測量

並列摘要

Anterior cruciate ligament tear is one of the common major knee injuries. When it is suspected that the patient has the anterior cruciate ligament injury, the X-ray imaging can not provide help for ligament tissue, so MRI must be used for diagnosis. Because of its long time for registering, it is not possible to quickly rule out abnormalities of the anterior cruciate ligament. The purpose of this study is to provide the theoretical basis for early clinical diagnosis or treatment options to estimate the injury of the anterior cruciate ligament by the patella height ratio measurement (Insall-Salvati index, IS index) on the lateral standing knee joint X-ray. We retrospectively collected 111 patients who had the lateral standing knee joint X-ray imaging and MRI examination report showing the anterior cruciate ligament tear, and 41 patients who had the lateral standing knee joint X-ray imaging and MRI reports showing no abnormalities. The patients were young adults (aged 20 to 50 years old) and had no knee surgery, and all of the X-ray imaging were in good quality and positioning. The IS index imaging parameter quantitative method is measured by the PACS imaging system on the lateral standing knee joint X-ray and the SPSS 17.0 statistical tool is used for data analysis. The IS index of the anterior cruciate ligament tear group was significantly lower than the normal control group on average (1.01 ± 0.15 vs 1.08 ± 0.15, p=0.01). In addition, it is analyzed by gender, it shows that IS index of male are lower than female in the normal control group (1.06 ± 0.13 vs 1.09 ± 0.16, p=0.555), and in the anterior cruciate ligament tear group (0.99 ± 0.14 vs 1.03 ± 0.15, p=0.167) respectively. In conclusion, we can use the IS index measurement method to indicate that it may potentially increase the occurrence of anterior cruciate ligament tears on the low position of the patella (patella baja). Based on the results of statistical analysis, we can get the conclusions: On the lateral standing knee joint X-ray images with good positioning and image quality, the IS index measurement can be used to indicate that it may potentially increase the occurrence of anterior cruciate ligament tears on the low position of the patella (patella baja) and provide clinicians with another diagnosis reference.

並列關鍵字

anterior cruciate ligament tear ； Insall-Salvati index ； lateral standing knee joint X-ray