| Abstract: | 本篇研究目的是在發展一種比較簡易的測量方法，經由表淺部位「膝部內側股骨脛骨內緣垂直距離」（膝內側股脛距）的測量，來作為後十字韌帶斷裂的診斷及膝部穩定性評估，並進行其信度分析。韌帶斷裂組：經磁振造影證實有急性後十字韌帶斷裂有7人，對照組：其他原因膝部疼痛12人。對照組比較左右兩側膝之「膝內側股脛距」，左/右膝為0.46±0.13cm及0.44±0.14cm，兩者沒有統計上的差異，韌帶斷裂組患/健測膝為0.15±0.27cm及0.44±0.11cm，兩者有顯著的差異(p<0.01)。在信度方面，重複做過2次測量的膝蓋(n=34)，其測量的均值差為0.01±0.07cm, ICC=0.96, p=0.43，有極良好的測量信度；若是單看患膝的部分(n=5)，測量的均值差為0.02±0.08cm, ICC=0.97, p=0.60，其信度一樣相當好。所以我們得到結論當(1)患側「膝內側股脛距」比健側短，加上(2)兩側「膝內側股脛距的差距」大於0.14cm時，會強烈懷疑有後十字韌帶斷裂(specificity 100 %，sensitivity 86%)，此時將進行更深入的檢查。另外對於斷裂後，膝關節內外向(M-L direction)的穩定性，可由此「膝內側股脛距的差距」作前後比較，提供是否還需進行手術介入的依據。
Objectives: To develop a simple sonographic measurement, the medial knee tibiofemoral vertical length (MTFL), to do the diagnosis of isolated PCL tear, the assessment of knee instability and it’s intrarater reliability. Design: Patients with torn PCL (n=7) were studied, and the others with knee pain (n=12) were as control. Sonographic MTFL measurements were obtained from both of them. Results: The values of MTFL were 0.46± 0.13 cm(left knee) vs 0.44± 0.14 cm (right knee) in the control group, and there were no difference in them (p=0.26). In the study group, the values of MTFL were 0.15± 0.27 cm vs 0.44± 0.11 cm, and the difference became significant (p<0.01). About the intrarater reliability, the knees with 2 repeated-measurement (n=34) had a mean difference of 0.01 ± 0.07 cm, ICC = 0.96 , p=0.43. If isolated the torn PCL knees (n=5), the mean difference was 0.02±0.08 cm, ICC=0.97, p=0.60. They both had very good intrarater reliability. Conclusions: We would highly suspect that the PCL was torn when (1) the MTFL was less than sound side, and (2) the MTFL difference of both knees > 0.14 cm were met (specificity 100%, sensitivity 86%), and further studies would be arranged. The M-L direction stability could be assessed and compared with the last measurement as a guide to consider whether or not to refer for surgical intervention. |
