胫骨结节-滑车沟距离与股骨滑车发育形态相关的影像学分析  

Imaging analysis of the correlation between tibial tuberosity-trochlea groove distance and femoral trochlea morphology

作　　者：周元博 黄文亮[2] 王晋东[1] Zhou Yuanbo;Huang Wenliang;Wang Jindong(Second Hospital of Shanxi Medical University,Taiyuan 030000,Shanxi Province,China;Second Affiliated Hospital of Luohe Medical College,Luohe 462000,Henan Province,China)

机构地区：[1]山西医科大学第二医院,山西省太原市030000 [2]漯河医学高等专科学校第二附属医院,河南省漯河市462000

出　　处：《中国组织工程研究》2021年第27期4390-4394,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:股骨滑车发育不良是导致髌股关节不稳的最重要危险因素,对于滑车发育的形态是先天基因决定的还是与后天髌股关节间的应力刺激有关,目前尚没有定论,因胫骨结节-滑车沟距离的大小会影响髌股关节内外侧的压力,所以通过分析胫骨结节-滑车沟距离与股骨滑车发育形态是否存在相关性,来验证滑车发育形态是否与后天髌骨应力的刺激有关。目的:探索胫骨结节-滑车沟距离与股骨滑车发育形态的相关性。方法:回顾性分析2019年6至8月在漯河医学高等专科学校第二附属医院就诊患者的膝关节CT图像,纳入154例患者,其中男80例,女74例,年龄18-55岁。根据评估滑车不良的Dejour分型法,分为滑车发育不良组(DejourA型、B型、C型、D型)和正常组(沟角≤145°),并在影像分析系统上测量胫骨结节-滑车沟距离和股骨滑车形态学指标(滑车的沟角、滑车外侧倾斜角、内外侧滑车高度、中心滑车高度、滑车深度、滑车面不对称性)。采用曼-惠特尼U检验比较滑车发育不良组与正常组的胫骨结节-滑车沟距离的差异,采用Pearson相关分析来研究胫骨结节-滑车沟距离与股骨滑车发育形态的相关性。结果与结论:滑车不良组比正常组有更大的胫骨结节-滑车沟距离(P<0.001),胫骨结节-滑车沟距离与大部分滑车形态学指标存在相关性:滑车沟角(r=0.487,P<0.001)、外侧倾斜角(r=-0.286,P<0.001)、内侧滑车高度(r=-0.174,P=0.031)、滑车深度(r=-0.299,P<0.001)、滑车面不对称性(r=-0.301,P<0.001)、Dejour分型(r=0.496,P<0.001),而与外侧滑车高度(r=0.001,P=0.993)、中心滑车高度(r=0.102,P=0.210)没有发现相关性。结果表明,胫骨结节-滑车沟距离增大与股骨滑车发育不良存在相关性,支持了髌股关节应力刺激会影响股骨滑车发育的假说,为临床治疗儿童髌股关节不稳提供了理论依据。BACKGROUND:Femoral trochlear dysplasia is the most important risk factor for patellofemoral instability.There is no consistent conclusion as to whether the morphology of femoral trochlear is determined by congenital genes or related to the stimulation of the patellofemoral compression.The tibial tuberositytrochlea groove distance can affect the pressure of the patellofemoral joint,so the relationship between the tibial tuberosity-trochlea groove distance and femoral trochlear morphology was analyzed to verify whether the trochlear morphology is related to the stress stimulation of patella.OBJECTIVE:To investigate the relationship between tibial tuberosity-trochlea groove distance and trochlea morphology.METHODS:A total of 154 CT scans from June to August 2019 in Second Affiliated Hospital of Luohe Medical College were analyzed retrospectively.There were 80 males and 74 females,aged 18-55 years.Based on Dejour trochlea classification,the subjects were divided into two groups:trochlea dysplasia group(types A-D)and normal group(sulcus angle≤145°).Researchers measured tibial tuberosity-trochlea groove distance and radiologic parameters characterizing the form of trochlea,including sulcus angle,the lateral trochlea slope,trochlea height(medial,central,lateral),trochlea depth,and trochlea facet asymmetry.The Man-whitney U test was used to evaluate differences in tibial tuberosity-trochlea groove distance between trochlea group and normal group.Pearson correlation analysis was performed between tibial tuberosity-trochlea groove distance and parameters of trochlea morphology.RESULTS AND CONCLUSION:Trochlea dysplasia group showed higher values for tibial tuberosity-trochlea groove distance than normal group(P<0.001).Tibial tuberosity-trochlea groove distance significantly correlated with most trochlea parameters evaluated,including sulcus angle(r=0.487,P<0.001),the lateral trochlea slope(r=-0.286,P<0.001),medial trochlea height(r=-0.174,P=0.031),trochlea depth(r=-0.299,P<0.001),trochlea facet asymmetry(r=-0.301,P<0.001

关 键 词：髌股关节不稳 胫骨结节-滑车沟距离 滑车发育不良 CT Dejour分型 滑车沟角 相关性分析 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]