胫骨结节-股骨滑车间距离对于髌骨不稳的预测价值研究  

Predictive Value of Tibial Tuberosity-trochlear Groove Distance for Patellar Instability

作　　者：安伟 张浩沙强 张新刚 贺莎莎 AN Wei;ZHANG Hao-sha-qiang;ZHANG Xin-gang;HE Sha-sha(Orthopedics Department of Urumqi International Hospital,Urumqi 830000,Xinjiang,China)

机构地区：[1]乌鲁木齐国际医院骨科,新疆乌鲁木齐830000

出　　处：《医学信息》2024年第8期95-98,103,共5页Journal of Medical Information

基　　金：乌鲁木齐市卫生健康委科技计划项目(编号:202042)。

摘　　要：目的探讨胫骨结节-股骨滑车间(TT-TG)距离对于髌骨不稳的预测价值。方法纳入2021年1月-2022年8月因半月板损伤或可疑膝关节疼痛,在我院骨科住院的101例患者作为研究对象。按术中关节镜检查是否明确诊断为髌骨不稳分为髌骨不稳组54例(53.47%)和非髌骨不稳组47例(46.53%),比较两组患者基本人口学特征以及解剖学参数。以单因素分析中有统计学意义的指标作为自变量代入多因素Logistic回归模型进行分析。采用最大似然比前进法筛选出髌骨不稳的独立预测因素,重点分析TT-TG距离与髌骨不稳的相关性,绘制独立预测因素预测髌骨不稳的ROC曲线,进一步分析独立预测因素的预测效能。结果髌骨不稳组患者股骨前倾角、膝关节扭转角、TT-TG距离以及高位髌骨所占比例高于非髌骨不稳组(P<0.05);两组患者胫骨外旋角、Caton指数以及滑车发育不良比较,差异无统计学意义(P>0.05);多因素Logistic回归分析结果显示,股骨前倾角、膝关节扭转角以及TT-TG距离为髌骨不稳的独立预测因素(P<0.05),其中TT-TG距离每增加1 mm,患者髌骨不稳的患病风险增加2.246倍(OR:3.246,95%CI:1.029~6.435,P=0.003);ROC分析结果显示,股骨前倾角、膝关节扭转角以及TT-TG距离预测髌骨不稳的曲线下面积(AUC)分别为0.834(95%CI:0.756~0.887)、0.776(95%CI:0.715~0.838)以及0.811(95%CI:0.732~0.875),预测髌骨不稳的最佳诊断截点分别为28.5度、14.1度以及22.5 mm,三者联合预测的AUC为0.928(95%CI:0.887~0.975)。结论股骨前倾角、膝关节扭转角以及TT-TG距离对于髌骨不稳均具有良好的预测效能,并且三者联合预测的预测价值最高。Objective To investigate the predictive value of tibial tuberosity-trochlear groove distance(TT-TG)for patellar instability.Methods From January 2021 to August 2022,101 patients hospitalized in the Department of Orthopedics of our hospital due to meniscus injury or suspected knee joint pain were included in the study.The patients were divided into patellar instability group(54 patients,53.47%)and non-patellar instability group(47 patients,46.53%)according to whether patellar instability was clearly diagnosed by intraoperative arthroscopy.The basic demographic characteristics and anatomical parameters of the two groups were compared.The statistically significant indicators in the univariate analysis were substituted into the multivariate logistic regression model as independent variables for analysis.The maximum likelihood ratio forward method was used to screen out the independent predictors of patellar instability.The correlation between TT-TG distance and patellar instability was analyzed.The ROC curve of independent predictors to predict patellar instability was drawn to further analyze the predictive efficacy of independent predictors.Results The proportion of femoral anteversion angle,knee joint torsion angle,TT-TG distance,and high patella in the patellar instability group was significantly higher than that in the non-patellar instability group(P<0.05).There was no statistically significant difference between the two groups in terms of tibial lateral rotation angle,Caton index,and pulley dysplasia(P>0.05).Multivariate Logistic regression analysis showed that femoral anteversion angle,knee joint torsion angle and TT-TG distance were independent predictors of patellar instability(P<0.05).For every 1 mm increase in TT-TG distance,the risk of patellar instability increased by 2.246 times(OR:3.246,95%CI:1.029-6.435,P=0.003).ROC analysis showed that the area under the curve(AUC)of femoral anteversion,knee torsion angle and TT-TG distance for predicting patellar instability were 0.834(95%CI:0.756-0.887),0.776(95%C

关 键 词：胫骨结节-股骨滑车 髌骨不稳 独立预测因素 

分 类 号：R681[医药卫生—骨科学]