摘要
目的探讨伸膝状态下髌骨倾斜角和适合角对复发性髌骨脱位(EPD)的诊断价值、髌骨和股骨横断面参数测量值及其与髌股关节横断面匹配关系的相关性和影响程度。方法采用病例对照研究分析2016年1月至2019年12月上海交通大学附属第六人民医院收治的EPD患者(EPD组,106例)和无髌骨不稳患者(对照组,106例)的影像学资料,1∶1匹配,各组男51例,女55例;年龄14~45岁[(23.0±5.3)岁]。横断面测量参数包括髌骨参数:髌骨宽度、髌骨厚度、Wiberg角及Wiberg指数;股骨参数:滑车沟角、滑车沟深度、滑车沟高度、滑车宽度比(外/内)、滑车高度比(外/内)、外侧滑车倾斜角及滑车内移程度;髌股关节参数:髌骨倾斜角和适合角。以受试者工作特征(ROC)曲线分析髌股关节参数对EPD的预测效能。采用单因素分析两组横断面测量参数之间的差异。采用Pearson相关性分析明确各骨性参数与髌股关节参数之间的相关性。采用逐步回归模型进一步明确影响髌股关节参数的因素及影响程度。结果当髌骨倾斜角、适合角最佳界值分别为17.2°和25.5°时,预测EPD的ROC曲线下面积(AUC)分别为0.91(95%CI 0.87~0.95,P<0.01)和0.92(95%CI 0.87~0.95,P<0.01)。Youden指数分别为0.745(敏感度为83.96%,特异度为90.57%)和0.717(敏感度为81.13%,特异度为90.57%)。单因素分析结果显示,两组Wiberg指数、股骨参数和髌股关节参数差异有统计学意义(P均<0.01)。Pearson相关性分析结果显示,所有患者中髌骨倾斜角与Wiberg指数、滑车沟角、滑车沟深度、滑车宽度比(外/内)、滑车高度比(外/内)和外侧滑车倾斜角呈显著中等程度相关或强相关(r=0.51,0.41,-0.62,0.43,-0.49,-0.65,P均<0.01);适合角与滑车沟角、滑车沟深度、滑车宽度比(外/内)和外侧滑车倾斜角呈显著中等程度相关(r=0.43,-0.59,0.38,-0.51,P均<0.01)。逐步回归模型分析结果显示,所有患者中外侧滑车倾斜角、滑车沟深度、滑车沟角、Wiberg指数和滑车高度比(外/内)可解释髌骨倾斜角60%的变异(R2=0.60,P<0.01);滑车沟深度、外侧滑车倾斜角、滑车内移程度、滑车沟角和Wiberg指数可解释适合角44%的变异(R2=0.44,P<0.01)。结论髌骨倾斜角和适合角是反映髌股关节横断面匹配关系的定量指标,具有较优的EPD诊断价值;EPD患者髌骨和股骨骨性结构的改变与髌股关节横断面匹配关系有关,且不同横断面参数对髌股关节横断面匹配关系的影响程度不同。
Objective To explore the diagnostic performance of patella-tilt angle and congruence angle in episodic patellar dislocation(EPD)and the quantitative measurements of the patellar and femoral axial parameters as well as their correlation with and contributions to the patellofemoral joint alignment with the knee extended.Methods A case control study was conducted to analyze the radiological data of EPD patients(EPD group,n=106)and patients without patellar instability(control group,n=106)admitted to Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January 2016 to December 2019.Each group consisted of 55 females and 51 males with the age range of 14-45 years[(23.0±5.3)years],showing 1∶1 match.Axial parameters included patellar parameters(patellar width,patellar thickness,Wiberg angle and Wiberg index),femoral parameters[trochlear sulcus angle,trochlear sulcus depth,trochlear sulcus height,trochlear width ratio(lateral/medial),trochlear height ratio(lateral/medial),lateral trochlear inclination and trochlear groove medialization],and patellofemoral joint parameters(patellar tilt angle and congruence angle).The receiver operating characteristic(ROC)curve of patellofemoral joint parameters for the prediction of EPD was analyzed.Univariate analysis was performed to determine the difference of those axial parameters between the two groups.Pearson correlation analysis was used to identify the correlation between those bony parameters and patellofemoral joint parameters.Stepwise regression model was further established to determine the influencing factors and corresponding contributions for patellofemoral joint parameters.Results When the optimal cut-off values of patellar tilt angle and congruence angle were 17.2°and 25.5°,the area under the ROC curve(AUC)for predicting EPD was 0.91(95%CI 0.87-0.95,P<0.01)and 0.92(95%CI 0.87-0.95,P<0.01),and the Youden index was 0.745(sensitivity=83.96%,specificity=90.57%)and 0.717(sensitivity=81.13%,specificity=90.57%).Univariate analysis showed that Wiberg index,femoral parameters and patellofemoral joint parameters were significantly different between the two groups(all P<0.01).For all patients,Pearson correlation analysis showed that patellar tilt angle was moderately to strongly correlated with Wiberg index,trochlear sulcus angle,trochlear sulcus depth,trochlear width ratio(lateral/medial),trochlear height ratio(lateral/medial)and lateral trochlear inclination(r=0.51,0.41,-0.62,0.43,-0.49,-0.65,all P<0.01)and that congruence angle has a moderate correlation with trochlear sulcus angle,trochlear sulcus depth,trochlear width ratio(lateral/medial)and lateral trochlear inclination(r=0.43,-0.59,0.38,-0.51,all P<0.01).For all patients,Stepwise regression model analysis showed that lateral trochlear inclination,trochlear sulcus depth,trochlear sulcus angle,Wiberg index and trochlear height ratio(lateral/medial)could explain 60%of the variation of patellar tilt angle(R2=0.60,P<0.01)and that trochlear sulcus depth,lateral trochlear inclination,trochlear groove medialization,trochlear sulcus angle and Wiberg index could explain 44%of the variation of congruence angle(R2=0.44,P<0.01).Conclusions The patellar tilt angle and congruence angle are reliable quantitative indicators representing patellofemoral axial alignment,with a good diagnostic performance for EPD.Variations in the patellar and femoral bony structures of EPD patients are related to the patellofemoral axial alignment,with the axial parameters differently contributing to the patellofemoral alignment.
作者
陈杰波
叶梓鹏
伍晨亮
蒋佳
谢国明
赵金忠
Chen Jiebo;Ye Zipeng;Wu Chenliang;Jiang Jia;Xie Guoming;Zhao Jinzhong(Department of Sports Medicine,Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第7期600-606,共7页
Chinese Journal of Trauma
基金
国家重点研发计划(2018YFC1106200,2018YFC1106202)。
关键词
髌骨脱位
髌股关节
横断面
Patellar dislocation
Patellofemoral joint
Cross-sectional
