髌股关节不稳的新评估指标:胫骨结节扭转角  

A new evaluation index for patellofemoral instability:tibial nodule torsion angle

作　　者：李维祥 徐斌[1] 姜少伟[1] Li Weixiang;Xu Bin;Jiang Shaowei(Department of Sports Trauma and Arthroscopic Surgery,First Affiliated Hospital of Anhui Medical University,Hefei 230032,Anhui Province,China)

机构地区：[1]安徽医科大学第一附属医院运动创伤与关节镜外科,安徽省合肥市230032

出　　处：《中国组织工程研究》2022年第36期5781-5786,共6页Chinese Journal of Tissue Engineering Research

基　　金：安徽省自然科学基金项目(1808085MH243),项目负责人:徐斌。

摘　　要：背景:髌骨脱位多见于年轻女性患者,是引起青少年膝关节疼痛的常见病因,对于髌骨脱位的治疗,临床分为手术治疗和保守治疗,手术治疗一般多选用内侧髌股韧带重建,而术后发生再次脱位的原因可能是未能纠正危险因素,需要联合行截骨矫形治疗,以此改变骨骼的解剖结构和纠正骨骼畸形,但术前患者是否需要联合行胫骨结节截骨矫形术,目前临床上仍然存在争议。目的:介绍影响髌股关节稳定性的一项新评估指标——胫骨结节扭转角,测量并分析胫骨结节扭转角与髌骨脱位之间的相关性,研究胫骨结节扭转角对髌骨脱位的诊断与临床实用价值,评估胫骨结节扭转角与胫骨结节-股骨滑车间距离和髌骨倾斜角之间的相关性。方法:收集安徽医科大学第一附属医院骨科运动创伤与关节镜外科2020年1-8月收治的髌骨脱位患者42例、对照组(交叉韧带损伤或半月板损伤患者)46例的病历资料,分别于CT下测量两组患者的胫骨结节扭转角、胫骨结节-股骨滑车间距离、髌骨倾斜角,并进行统计学分析,分析胫骨结节扭转角与髌骨脱位之间的相关性,并评估胫骨结节扭转角的临床应用价值。结果与结论:①胫骨结节扭转角在两组之间差异有显著性意义(P<0.05);②胫骨结节扭转角相较于另外2个参数可以作为髌骨脱位的一项危险因素,并且对髌骨脱位具有一定的诊断能力(曲线下面积=0.923);③提示胫骨结节扭转角与髌骨脱位之间密切相关,并且对髌骨脱位具有一定的诊断能力,相较于另外2个参数可纳入影响髌股关节稳定性的因素中,用于术前评估,为髌骨脱位修复方式的选择提供参照。BACKGROUND:Patellar dislocation is more common in young female patients,and it is a common cause of adolescent knee pain.For the treatment of patellar dislocation,clinical treatment is divided into surgical treatment and conservative treatment.Surgical treatment generally chooses the medial patellofemoral ligament revascularization.Postoperative recurrence of dislocation may be due to failure to correct risk factors,which requires combined osteotomy and orthopedic treatment.In this way,the anatomical structure of the bone can be changed and the skeletal deformity can be corrected.However,it is still controversial in clinic whether patients need to undergo tibial nodule osteotomy and orthopedic surgery before surgery.OBJECTIVE:A new evaluation index affecting the stability of patellofemoral joint is introduced.Tibial nodule torsion angle:The correlation between tibial nodule torsion angle and patellar dislocation was measured and analyzed.The diagnostic and clinical practical values of tibial nodule torsion angle for patellar dislocation were studied,and the correlation of tibial nodule torsion angle with tibial tubercle-trochlear groove distance and patellar inclination angle was evaluated.METHODS:A total of 42 patients with bone dislocation were collected from the Department of Sports Trauma and Arthroscopic Surgery of First Affiliated Hospital of Anhui Medical University from January to August 2020,and 46 patients with cruciate ligament injury or meniscus injury were considered as the control group.Tibial nodule torsion angle,tibial tubercle-trochlear groove distance and patellar inclination angle of the two groups were measured under CT.The three parameters of the data of the two groups were statistically analyzed.The correlation between tibial nodule torsion angle and patellar dislocation was analyzed and the clinical application value of tibial nodule torsion angle was evaluated.RESULTS AND CONCLUSION:(1)Tibial nodule torsion angle was statistically different between the two groups(P<0.05).(2)Compared with t

关 键 词：髌骨脱位 髌股关节稳定性 胫骨结节扭转 胫骨结节-股骨滑车间距离 髌骨倾斜角 胫骨结节截骨 

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