摘要
目的:探讨复发性髌骨脱位中膝关节扭转程度与下肢多重骨性结构不良之间的潜在关联。方法:回顾性收集2020年5月至2024年10月期间就诊于本机构的复发性髌骨脱位患者的术前影像学资料。共纳入238名患者,其中女性占比83.6%。所有患者均进行了标准的髋-膝-踝CT扫描。采用Mimics 20.0重建并测量下肢骨性结构参数,主要包括:膝关节扭转角、股骨前倾、股骨远端扭转角、滑车突起、股骨滑车沟基底-胫骨结节间距、Caton-Deschamps指数、胫骨扭转。依据既往的风险阈值对骨性异常进行分类。采用卡方检验比较膝扭转与下肢多重骨性异常结构之间的构成比差异。结果:在所有患膝中,高度膝关节扭转比例为33.6%。在上述骨性结构异常中,合并高度膝扭转的比例均超过40%。与低度膝扭转相比,高度膝扭转病例股骨过度前倾(41.3%vs.27.2%,P=0.028)、股骨远端过度扭转(60%vs.32.9%,P<0.001)、滑车凸起(55%vs.38.6%,P=0.016)、滑车发育不良(93.8%vs.73.4%,P<0.001)、胫骨结节过度外偏(68.8%vs.43.7%,P<0.001)及高位髌骨(50%vs.22.2%,P<0.001)比例均明显增大。此外,在高度膝扭转中,95%的膝关节伴随两项或更多的骨性风险因素;而55%的膝关节合并四项或更多的骨性结构不良,与低度膝扭转相比,差异具有统计学意义(55%vs.21.5%,P<0.001)。结论:在复发性髌骨脱位中,合并高度膝扭转的病例同时具有多种下肢骨结构异常。高度膝扭转(>12°)的病例中合并多重骨性结构异常的比例显著高于低度膝扭转病例。由此,在诊疗复发性髌骨脱位时,需充分评估下肢骨性结构异常,以指导合理的手术决策。
Objective To explore the association between knee torsion and multiple bony abnormali⁃ties of the lower limb in patients with recurrent patellar dislocation(RPD).Methods The preoperative imaging data of RPD patients treated in our institution between May 2020 and October 2024 were col⁃lected retrospectively.A total of 238 patients were included in this study,with 83.6%being females.All patients underwent standard hip-knee-ankle CT scans,and lower limb bony structural parameters were reconstructed and measured using Mimics 20.0,focusing on variables such as knee torsion,femo⁃ral anteversion(FAA),femoral distal torsion angle(DFTA),supratrochlear spur,tibial tuberosity to trochlear groove distance(TT-TG),Caton-Deschamps index,and tibial torsion.Bony abnormalities were categorized based on previously established risk thresholds.Moreover,chi-square tests were em⁃ployed to compare the composition ratio differences between knee torsion and multiple lower limb osse⁃ous abnormalities.Results Among all affected knees,the proportion of excessive knee torsion was 33.6%,while in cases with osseous abnormalities,the value was over 40%.Compared with cases of low knee torsion,patients with excessive knee torsion showed significantly higher proportions of FAA(41.3%vs.27.2%,P=0.028),excessive DFTA(60%vs.32.9%,P<0.001),supratrochlear spur(55%vs.38.6%,P=0.016),trochlear dysplasia(93.8%vs.73.4%,P<0.001),excessive TT-TG(68.8%vs.43.7%,P<0.001),and patella alta(50%vs.22.2%,P<0.001).Additionally,95%of knees with excessive torsion exhibited two or more bony risk factors,whereas 55%had four or more bony structural abnormalities,which was significantly higher than those of low knee torsion(55%vs.21.5%,P<0.001).Conclusion In RPD patients,excessive knee torsion is associated with multiple low⁃er limb bony abnormalities.Moreover,patients with high knee torsion(>12°)are significantly more likely to have multiple bony abnormalities than those with low torsion.Therefore,in surgical decisionmaking for such patients,lower limb bony abnormalities should be assessed comprehensively.
作者
张辉
王道峰
王雪松
洪雷
李悦
吴关
曹晏维
Zhang Hui;Wang Daofeng;Wang Xuesong;Hong Lei;Li Yue;Wu Guan;Cao Yanwei(Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China)
出处
《中国运动医学杂志》
北大核心
2025年第4期257-263,共7页
Chinese Journal of Sports Medicine
基金
国家自然科学基金(82472527)。
关键词
复发性髌骨脱位
膝扭转
多重骨性结构不良
髌骨轨迹
recurrent patellar dislocation
knee torsion
multiple bony abnormalities
patellar tracking
