复发性髌骨脱位"J"形征的分度及危险因素分析  

Risk factors and new grading system of J sign in recurrent patellar dislocation patients

作　　者：张志军 张辉[1] 宋关阳[1] 郑峒 冯华[1] Zhang Zhijun;Zhang Hui;Song Guanyang;Zheng Tong;Feng Hua(Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院运动损伤科,100035

出　　处：《中华骨科杂志》2019年第7期385-391,共7页Chinese Journal of Orthopaedics

基　　金：国家高技术研究发展计划(2015AA043204);北京市医院管理局临床医学发展专项经费(XMLX201613);北京市医院管理局"登峰"计划专项经费(DFL20180402).

摘　　要：目的提出一种新的复发性髌骨脱位"J"形征(屈膝30°至完全伸直过程中髌骨突然出现外侧移位)的分度方法并探讨其危险因素。方法从2017年1月至2018年8月就诊的复发性髌骨脱位患者中选取术前髌骨轨迹准确记录的患者111例,其中"J"形征阳性患者68例、"J"形征阴性患者43例。于膝关节纯侧位X线片测量Caton指数(>1.2定义为高位髌骨)和滑车发育Dejour分型(C型和D型定义为严重滑车发育不良),将CT图像进行叠加测量胫骨结节-股骨滑车(tibial tuberosity-trochlear groove,TT-TG)距离,同时使用三维重建CT图像测量下肢旋转参数(股骨前倾角、胫骨外旋角及膝关节扭转角)。比较两组解剖参数的差异,分析复发性髌骨脱位患者出现"J"形征的危险因素。根据终末伸膝阶段髌骨外移的形式和程度,制定新的"J"形征分度方法。结果复发性髌骨脱位"J"形征的发生率为61.3%(68/111)。"J"形征Ⅰ、Ⅱ和Ⅲ度患者分别为28、30和10例;随"J"形征分度的增加,股骨前倾角、胫骨外旋角、关节扭转角、TT-TG距离、Caton指数均有增大趋势。单因素分析结果显示"J"形征阳性组的股骨前倾角(t=3.376,P=0.001)、膝关节扭转角(t=4.886,P=0.001)、TT-TG距离(t=3.177,P=0.002)和高位髌骨发生率(χ^2=9.809,P=0.002)均大于"J"形征阴性组,组间差异有统计学意义;Logistic回归分析结果显示股骨前倾角增大(OR=1.118,P=0.012)、膝关节扭转角增大(OR=1.178,P=0.016)和高位髌骨(OR=3.229,P=0.040)是复发性髌骨脱位出现"J"形征的三个独立危险因素。结论对CT片上股骨前倾角增大、膝关节扭转角增大以及表现为高位髌骨的复发性髌骨脱位患者应警惕"J"形征的出现。Objective To investigate the risk factors of J sign in patients with recurrent patellar dislocation, and to establish a new grading system of J sign. Methods From January 2017 to August 2018, a consecutive case series of 111 recurrent patellar dislocation patients were included in the present study. Among these patients, a total of 68 patients had positive J sign (J sign (+) group), and the remaining 43 patients had negative J sign (J sign (-) group). Caton index, Dejour classification, tibial tuberosity- trochlear groove (TT-TG) distance and rotational parameters of the lower extremity (including femoral anteversion angle, external tibial torsion angle and knee rotation angle) were measured to compare the differences of these parameters between the intervention group and control group. Furthermore, the risk factors of J sign were analyzed in detail. Meanwhile, a new grading system of J sign was introduced based on the extent and form of lateral patellar shift. Results The prevalence of J sign in recurrent patellar dislocation was 61.3%(68/111). Univariate analysis showed that femoral anteversion angle (t=3.376, P=0.001), knee rotation angle (t=4.886, P=0.001), TT-TG distance (t=3.177, P=0.002) and prevalence of patellar alta (χ^2=9.809, P=0.002) were much higher in the J sign (+) group, and the differences were statistically significant when compared with the J sign (-) group. Multivariate Logistic regressions demonstrated that increased femoral anteversion angle (OR=1.118, P=0.012), enlarged knee rotation angle (OR=1.178, P=0.016) and patella alta (OR=3.229, P=0.040) were independent risk factors of J sign in patients with recurrent patellar dislocation. Conclusion Increased femoral anteversion angle, enlarged knee rotation angle, and patellar alta were strongly associated with J sign. These factors may be independent risk factors of J sign in patients with recurrent patellar dislocation.

关 键 词：髌骨脱位 关节不稳定性 危险因素 

分 类 号：R687.4[医药卫生—骨科学]