关节镜下评估髌骨轨迹不良严重程度的临床应用研究  

Clinical Application of Arthroscopic Assessment of the Severity of Patellar Maltracking

作　　者：王雪松[1] 张志军 张辉[1] Wang Xuesong;Zhang Zhijun;Zhang Hui(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院运动医学科,北京100035

出　　处：《中国运动医学杂志》2022年第10期747-751,共5页Chinese Journal of Sports Medicine

基　　金：北京积水潭医院院级青年基金(QN202202);国家自然科学基金(82172514);国家重点研发计划(2019YFF0301705)。

摘　　要：目的:探索髌骨轨迹不良严重程度与关节镜下髌骨复位角度的相关性,明确关节镜下评估髌骨轨迹的临床有效性。方法:从2017年1月至2018年12月连续就诊的患者中筛选出复发性髌骨脱位117例。术前采用髌骨J形征和髌骨平分指数(bisect offset index,BOI)评估髌骨轨迹不良的严重程度,术中使用关节镜观察屈伸膝过程中髌骨轨迹的动态变化,记录髌骨复位时的屈膝复位角度(knee flexion angle,KFA)。测量髌骨高度、胫骨结节-股骨滑车沟距离、股骨前倾角等影像学参数。采用Pearson相关分析BOI和KFA之间的相关性。结果:本研究共纳入117例复发性髌骨脱位,平均年龄为21.1±6.7岁,所有患者在镜下均能观察到髌骨轨迹不良。87.2%(102/117)的病例术前J形征阳性,术前BOI平均值为124%。Pearson相关性分析显示BOI和KFA为弱相关,相关系数0.24。不同J形征分度病例的KFA差异无统计学意义。结论:关节镜下评估是一种敏感的髌骨轨迹不良评估方法,但屈膝复位角度(KFA)这一参数与髌骨轨迹不良严重程度仅存在弱相关,KFA无法用于准确量化复发性髌骨脱位患者的髌骨轨迹不良程度。ObjectiveTo explore the correlation between the severity of patellar maltracking and the arthroscopic knee flexion angle,and to clarify the clinical validity of arthroscopic assessment of patellar maltracking.MethodsTotally 117 cases of recurrent patellar dislocation were screened out from patients who visited the clinic consecutively in year 2017 and 2018. The severity of patellar maltracking before operation was evaluated using the patellar J-sign and patellar bisect offset index(BOI). The changes of patellar tracking during knee flexion and extension in operation were observed under the arthroscopy,and the knee flexion angle(KFA) during the patella reduction was recorded. Imaging parameters such as the patella height,tibial tubercle-trochlear groove distance,and femoral anteversion angle were measured. Pearson correlation was employed to analyze the correlation between BOI and KFA.ResultsA total of 117 knees with recurrent patellar dislocation were included in this study,with an average age of 21.1 ± 6.7 years. All patients were observed patellar maltracking under the arthroscopy,with 87.2%(102/117) of preoperative J-sign and the mean preoperative BOI of 124%. Pearson correlation analysis showed that BOI and KFA were weakly correlated,with a correlation coefficient of 0.24.There was no significant difference in KFA among cases with different J-sign grades.ConclusionArthroscopic assessment is sensitive to screen out patellar maltracking,while KFA is only weakly correlated with the severity of patellar maltracking. Therefore,KFA cannot be used to accurately quantify the degree of patellar maltracking in RPD patients.

关 键 词：复发性髌骨脱位 髌骨轨迹不良 关节镜 

分 类 号：R687.3[医药卫生—骨科学]