初次髌骨脱位合并膝关节游离体患者再次脱位危险因素分析  

Risk Factors Analysis for Re-Dislocation of Patients with Primary Dislocation of Patella Combined with Loose Body of Knee Joint

作　　者：孙敏 林瓒 高志[1] 陈鹏旭 程松苗 胡勇[1] Sun Min;Lin Zan;Gao Zhi(Department of Knee Sports Injury,Sichuan Orthopedic Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川省骨科医院膝关节运动损伤科,四川成都610041

出　　处：《四川医学》2021年第7期721-725,共5页Sichuan Medical Journal

基　　金：四川省骨科医院院内课题(编号:209704)。

摘　　要：目的探讨初次髌骨脱位同时合并有膝关节游离体的患者,中远期内再次出现同侧髌骨脱位的风险及相关的危险因素。方法回顾性分析我院2014年1月到2018年12月膝关节运动损伤科收治的有效随访102例首次髌骨脱位同时合并膝关节游离体的患者,收集患者术前资料:骨骺愈合情况、体质指数、膝关节核磁共振测量指标,根据随访结果将患者分为未脱位组及再脱位组,比较两组间的各种测量指标明确髌骨再次脱位的危险因素。结果102例初次髌骨脱位患者中有39例(38.24%)在术后1~6年的随访期间内再次出现髌骨脱位。Logistic逐步回归分析表明,Insall指数(优势比1.98;95%CI 1.31~2.65;P=0.003)、滑车-胫骨结节距离/髌骨关节面长度(优势比3.20;95%CI 1.93~4.47;P=0.012)、髌骨偏移指数(优势比1.85;95%CI 1.03~2.68;P=0.025)、滑车沟角(优势比3.28;95%CI 2.21~4.35;P=0.002)是再脱位的重要预测因子。操作者工作曲线显示分割点分别为:Insall指数1.24,滑车-胫骨结节距离/髌骨关节面长度0.42,髌骨偏移指数>0.44,滑车沟角>150.9°。预测模型显示,当不存在以上4个高危因素时,髌骨再次脱位的风险为0.57%,当存在1个高危因素时,髌骨再次脱位风险为7.52%,当存在2个高危因素时,髌骨再次脱位风险为53.43%,当存在3个高危因素时,髌骨再次脱位风险为94.18%,当存在4个高危因素时,髌骨再次脱位风险为99.56%。结论Insall指数、滑车-胫骨结节距离/髌骨关节面长度、髌骨偏移指数、滑车沟角是初次髌骨脱位伴有膝关节游离体患者再次脱位的高危因素。合并存在的高危因素越多,髌骨再次脱位的风险越大。Objective To assess related risk factors for re-dislocation of patients diagnosed with primary patella dislocation with loose body in medium or long period.Method From Jan 2014 to Dec 2018,102 participants diagnosed with primary patella dislocation with loose body in our department were retrospectively involved.Several factors were studied,including skeletal maturity,BMI,anatomic factors measured on MRI.According to the follow-up results,patients were divided into non-dislocation group and re-dislocation group.Various measurement indexes were compared to clarify risk factors of patella re-dislocation.Results 39 cases(38.24%)of total 102 participants experienced re-dislocation during follow-up at 1-6yeats after surgery.Logistic step-wise regression analysis showed that the Insall index[hazard ratio(HR)1.98,95%confidence interval(CI)1.31~2.65,P=0.003],pulley-tibial tubercle/patella articular surface length(HR 3.20,95%CI 1.93~4.47,P=0.012),patella deviation index(HR 1.85,95%CI 1.03~2.68,P=0.025),and trochlear groove angle(HR 3.28,95%CI 2.21~4.35,P=0.002)were risk factors of re-dislocation.ROC curve showed that cut-off point were 1.24 for Insall sex,0.42 for pulley-tibial tubercle/patella articular surface length,0.44 for patella offset index,150.9°for trochlear groove angle.Prediction model showed that re-dislocation risk was 0.57%for no risk factors,7.52%for one risk factor,53.43%for two risk factors,94.18%for three risk factors,and 99.56%for four risk factors.Conclusions Insall sex,ration of pulley-tibial tubercle/patella articular surface length,patella offset index,trochlear groove angle could be risk factors for re-dislocation of primary patella dislocation patients with loose body.The more risk factors exits,the greater probability re-dislocation happens.

关 键 词：初次髌骨外侧脱位 再脱位 危险因素 游离体 

分 类 号：R684.7[医药卫生—骨科学]