目的 探讨前交叉韧带重建术（ACLR）中股骨隧道定位差异对术后早期脑功能重塑的影响。方法 纳入2022年2月—2024年2月收治的单侧左膝前交叉韧带完全断裂患者18例,术后CT三维重建量化隧道位置,分为隧道正常组（G1组, n=9）、隧道偏前组（G2组, n=9）,并设健康对照组（HC组, n=10）。记录三组基线数据及临床资料,术后8~12周时随访采集静息态fMRI数据,计算低频振幅（ALFF）,比较各组间差异。结果 三组基线数据及术后早期临床评分差异无统计学意义（P>0.05）。G1与G2组ALFF差异未达显著水平（P>0.05）,两组均较HC组出现右侧额叶、双侧颞叶及左小脑后叶ALFF升高。G2组右眶额中回、左小脑8区激活更集中,伴右侧中央前回、双侧缘上回及双枕叶舌回抑制。结论 ACLR术后早期,股骨隧道定位差异尚未显著影响整体代偿性脑功能重塑模式,表现为额叶-颞叶-小脑共性上调;但隧道偏前组出现特定脑区抑制信号,提示精细运动控制受损。基于股骨隧道定位及脑区激活特征制定个体化神经康复策略,有望为ACLR精准治疗提供新思路。
Objective To investigate whether femoral tunnel positioning during anterior cruciate ligament reconstruction （ACLR） modulates early postoperative brain functional plasticity. Methods In this study, 18 patients with unilateral left-knee anterior cruciate ligament rupture were enrolled between February 2022 and February 2024 and received postoperative CT-based 3D reconstruction quantified femoral tunnel position. The patients were categorized into a normal position （G1, n=9） and an anteriorly deviated （G2, n=9） groups. Ten healthy volunteers served as controls （HC）. Baseline and clinical data were recorded. Resting-state functional MRI （rs-fMRI） was acquired at 8-12 weeks postoperatively. Amplitude of low-frequency fluctuation （ALFF） was calculated and compared across groups. Results Baseline characteristics and early postoperative clinical outcomes were comparable among the three groups （P>0.05）. No significant ALFF differences were observed between G1 and G2 （P>0.05）. Compared with HC, both surgical groups exhibited increased ALFF in the right frontal cortex, bilateral temporal lobes, and posterior lobes of left cerebellum. Notably, G2 demonstrated more focal activation in the Frontal_Med_Orb_R and Cerebelum_8_L, accompanied by decreased ALFF in the Precentral_R, SupraMarginal_R, and Lingual gyrus （P<0.05）. Conclusion Early after ACLR, femoral tunnel positioning differences do not significantly alter the predominant pattern of cortical functional plasticity, characterized by frontal-temporal-cerebellar hyperactivation. However, it induces region-specific suppression in G2, indicating impaired fine motor control. These findings support incorporating femoral tunnel positioning and brain region activation signals into personalized neuro-rehabilitation strategies to provide new ideas for the precise treatment of ACLR.
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