CAJ | 학술논문

目的：探讨影响髌股关节不稳的主要解剖因素。方法回顾性分析2010年9月—2012年9月中山大学附属第三医院关节外科诊治的髌股关节不稳20例患者患侧膝关节MRI资料,并将其纳入髌股关节不稳组,其中男8例,女12例,年龄(24±8)岁；包括髌骨脱位、髌骨内侧支持带损伤等导致的髌股关节不稳,排除伴有膝关节多发韧带损伤、膝关节周围骨折、关节大量积液以及曾经进行膝关节手术的病例。选取同期诊断为髌股关节排列正常69例患者的MRI资料作为正常对照组,其中男31例,女38例,年龄(25±5)岁；排除伴有明显髌股关节不适症状、膝关节可疑骨折以及交叉韧带损伤的病例。测量两组MRI的髌骨高度、股骨滑车沟角、股骨滑车外侧面比例以及胫骨结节-滑车沟间距的数值,分别进行独立样本t检验,logistic回归分析其相关性。结果正常对照组和髌股关节不稳组的髌骨高度、股骨滑车外侧面比例、股骨滑车沟角、胫骨结节-滑车沟间距分别为1.02±0.15、0.63±0.13、145°±8°、(1.15±0.24) cm 和1.16±0.14、0.44±0.13、152°±8°、(1.69±0.27)cm,两组间各指标差异均有统计学意义(t 值分别为3.728、5.755、3.446、8.614,P 值均<0.01)。 Logistic回归分析显示,股骨滑车外侧面比例减少、股骨滑车沟角增大以及胫骨结节-滑车沟间距增大与髌股关节不稳的发病之间的相关性有统计学意义(P<0.05)。股骨滑车外侧面比例、胫骨结节-滑车沟间距以及股骨滑车沟角的标准偏回归系数为分别为-78.221、0.277和0.026。结论髌股关节不稳患者表现为髌骨高位、股骨滑车沟角增大、股骨滑车外侧面比例减少以及胫骨结节-滑车沟间距增大,其中胫骨结节-滑车沟间距增大以及股骨滑车外侧面比例减少是髌股关节不稳发病的主要因素。
목적：탐토영향빈고관절불은적주요해부인소。방법회고성분석2010년9월—2012년9월중산대학부속제삼의원관절외과진치적빈고관절불은20례환자환측슬관절MRI자료,병장기납입빈고관절불은조,기중남8례,녀12례,년령(24±8)세；포괄빈골탈위、빈골내측지지대손상등도치적빈고관절불은,배제반유슬관절다발인대손상、슬관절주위골절、관절대량적액이급증경진행슬관절수술적병례。선취동기진단위빈고관절배렬정상69례환자적MRI자료작위정상대조조,기중남31례,녀38례,년령(25±5)세；배제반유명현빈고관절불괄증상、슬관절가의골절이급교차인대손상적병례。측량량조MRI적빈골고도、고골활차구각、고골활차외측면비례이급경골결절-활차구간거적수치,분별진행독립양본t검험,logistic회귀분석기상관성。결과정상대조조화빈고관절불은조적빈골고도、고골활차외측면비례、고골활차구각、경골결절-활차구간거분별위1.02±0.15、0.63±0.13、145°±8°、(1.15±0.24) cm 화1.16±0.14、0.44±0.13、152°±8°、(1.69±0.27)cm,량조간각지표차이균유통계학의의(t 치분별위3.728、5.755、3.446、8.614,P 치균<0.01)。 Logistic회귀분석현시,고골활차외측면비례감소、고골활차구각증대이급경골결절-활차구간거증대여빈고관절불은적발병지간적상관성유통계학의의(P<0.05)。고골활차외측면비례、경골결절-활차구간거이급고골활차구각적표준편회귀계수위분별위-78.221、0.277화0.026。결론빈고관절불은환자표현위빈골고위、고골활차구각증대、고골활차외측면비례감소이급경골결절-활차구간거증대,기중경골결절-활차구간거증대이급고골활차외측면비례감소시빈고관절불은발병적주요인소。
Objective To assess the principle anatomic factors contributing to the incidence of patellofemoral joint instability. Methods Knee MRI evaluations of 20 patients who had the clinical diagnosis of patellofemoral joint instability in the Third Affiliated Hospital of Sun Yat-sen University from September 2010 to September 2012 were selected as patellar instability group [ 8 males, 12 females, the average age was ( 24 ± 8 ) years ] , including the patellar dislocation and injury of medial patellar retinaculum. The criteria for exclusion were any history of a multiple-ligament injury to the knee joint, an accompanying knee fracture, massive hydrarthrosis or a history of knee surgery. The MRI images of 69 asymptomatic subjects were selected as the asymptomatic group[31 males, 38 females, the average age was (25 ± 5) years]. None of these subjects had symptoms or objective pathologic findings related to the patellofemoral, fractures and ligament injury of knee. Patellar height, sulcus angle, sulcus lateral facet ratio, and the tibial tubercle trochlear groove ( TT-TG ) distance were measured in both groups. Independent-samples t test and logistic regression were used for statistic analysis. Results The mean values of patellar height, sulcus lateral facet ratio, sulcus angle, and TT-TG in asymptomatic group were 1. 02 ± 0. 15, 0. 63 ± 0. 13 , 145° ± 8°, (1. 15 ± 0. 24) cm, respectively;and the mean values of patellar height, sulcus lateral facet ratio, sulcus angle, and TT-TG in patellar instability group were 1. 16 ± 0. 14, 0. 44 ± 0. 13, 152° ± 8°, ( 1. 69 ± 0. 27 ) cm, respectively. Significant differences were observed between asymptomatic group and patellar instability group for all variables ( t=3. 728, t=5. 755, t=3. 446, t=8. 614, all P values<0. 01). Significant correlations between patellar instability and anatomic factors (TT-TG, sulcus lateral facet ratio, and sulcus angle) were observed by logistic regression (all P values<0. 05). Sulcus lateral facet ratio, the standardized partial regression coefficient were -78. 221, 0. 277 and 0. 026, respectively. Conclusions Patients with patellar instability show higher values of patellar height, TT-TG, and sulcus angle, and lower value of sulcus lateral facet ratio. TT-TG and sulcus lateral facet ratio may be the principal factors of patellar instability in Chinese population.