| 髌腱外偏角的测量及在复发性髌骨脱位诊断中的应用 |
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投稿时间：2021-06-01
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| 作者 | Author | 单位 | Address | E-Mail |
| 李健 |
LI Jian |
南华大学附属第一医院, 湖南 衡阳 421001 |
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China |
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| 戴祝 |
DAI Zhu |
南华大学附属第一医院, 湖南 衡阳 421001 |
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China |
oliverdai@hotmail.com |
| 廖瑛 |
LIAO Ying |
南华大学附属第一医院, 湖南 衡阳 421001 |
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China |
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| 吴彪 |
WU Biao |
南华大学附属第一医院, 湖南 衡阳 421001 |
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China |
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| 刘全辉 |
LIU Quan-hui |
南华大学附属第一医院, 湖南 衡阳 421001 |
Department of Orthopaedics, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China |
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| 期刊信息：《中国骨伤》2022年，第35卷，第6期，第532-537页 |
| DOI：10.12200/j.issn.1003-0034.2022.06.006 |
| 基金项目:湖南省卫生健康委员会重点课题资助项目(编号:20201907) |
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中文摘要:
目的:比较髌腱外偏角和胫骨结节-滑车沟距离(tibia tubercle-trochlea groove,TT-TG)的CT测量结果,以及在复发性髌骨脱位中的诊断能力和病理阈值。
方法:自2015年1月至2020年3月对46例复发性髌骨脱位患者和112例非髌骨脱位患者的病例资料进行回顾性分析。46例复发性髌骨脱位患者根据TT-TG值分为2组:TT-TG ≥ 20 mm髌骨脱位(A组)11例,男7例,女4例;年龄16~27(21.00±3.98)岁;TT-TG<20 mm髌骨脱位(B组)35例,男14例,女21例;年龄16~37(22.83±6.09)岁;非髌骨脱位(C组)112例,男63例,女49例;年龄16~36(22.87±5.69)岁。比较3组患者的髌腱外偏角和TT-TG值的测量数据,并采用Spearman分析其相关性。采用同类相关系数(intraclass correlation coefficient,ICC)确定组内的可重复性。利用受试者工作特征(receiver operating characteristic,ROC)曲线下面积评价参数的诊断能力,并计算出髌腱外偏角截骨参数,以及髌腱外偏角和TT-TG值在诊断复发性髌骨脱位的诊断参数。
结果:A、B、C组的髌腱外偏角分别为(22.04±3.19)°、(17.20±4.43)°、(10.22±3.45)°,TT-TG值分别为(21.15±0.71)、(15.97±2.69)、(11.12±3.77) mm,3组比较差异有统计学意义(P<0.01),且A组与B组比较差异有统计学意义(P<0.01)。髌腱外偏角与TT-TG值对比,存在强正相关(r=0.735,P<0.000 1)。髌腱外偏角在A、B组中的组内ICC值(0.980、0.982)比TT-TG值(0.594、0.775)测量的可重复性更好,C组中髌腱外偏角(0.956)和TT-TG值(0.906)可重复性均很好。在复发性髌骨脱位诊断中,髌腱外偏角的ROC曲线下面积(0.916)大于TT-TG值(0.886),其诊断参数分别为13.84°和14.69 mm;在胫骨截骨术中,髌腱外偏角的ROC曲线下面积为0.821,截骨参数为20.15°。
结论:CT成像可以可靠地测量髌腱外偏角。髌腱外偏角与TT-TG值存在强正相关,可通过其测量明确复发性髌脱位病理状态,并且髌腱外偏角在复发性髌骨脱位的诊断能力优于TT-TG值。髌腱外偏角同样可用于指导复发性髌骨脱位的胫骨截骨手术方案的制定。 |
| 【关键词】髌骨脱位|复发|髌腱 |
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| Measurement of external deviation angle of patellar tendon and its application on diagnosis of recurrent patellar dislocation |
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ABSTRACT
Objective: To compare computed tomography (CT) measurement results of external deviation angle of patellar tendon and tibia tubercle-trochlea groove (TT-TG),as well as the diagnostic ability and pathology in recurrent patellar dislocation threshold.
Methods: From January 2015 to March 2020,46 patients with recurrent patella dislocation and 112 patients with non-patella dislocation were retrospectively analyzed. Forty-six patients with recurrent patella dislocation were divived into 2 groups according to TT-TG value,11 patients with patellar dislocation with TT-TG ≥ 20 mm(group A),including 7 males and 4 females,aged from 16 to 27 years old with an average of(21.00±3.98) years old; 35 patients with patellar dislocation with TT-TG<20 mm(group B),including 14 males and 21 females,aged from 16 to 37 years old with an average of(22.83±6.09) years old. While 112 patients with non-patella dislocation(group C) included 63 males and 49 females,aged 16 to 36 years old with an average of(22.87±5.69) years old. The measurement data of external deviation angle of patellar tendon and TT-TG value among three groups were compared. Spearman analysis was used to analyze correlation among them. Intraclass correlation coefficient (ICC) was used to determine repeatability within group. Receiver operating characteristic (ROC) area under the curve was used to evaluate diagnostic ability of parameters,and calculate osteotomy parameters of external deviation angle of patellar tendon,as well as external deviation angle of patellar tendon and TT-TG value in the diagnosis of recurrent patella diagnostic parameters of dislocation.
Results: External deviation angle of patellar tendon in group A,B and C was (22.04±3.09)°,(17.20±4.43)ånd (10.22±3.45)° respectively;while TT-TG value was(21.15±0.71) mm,(15.97±2.69) mm and (11.12±3.77) mm,there were significance among three groups (P<0.01),and had difference between group A and B(P<0.01). There was strong positive correlation between external deviation angle of patellar tendon and TT-TG value (r=0.735,P<0.000 1). The intra- group ICC value(0.980,0.982) of external deviation angle of patellar tendon in group A and B have better repeatability than TT-TG value (0.594,0.775). The external deviation angle of patellar tendon in group C(0.956) and repeatability of TT-TG value(0.906) was very good. In the diagnosis of recurrent patellar dislocation,the area under ROC curve of external deviation angle of patellar tendon (0.916) was greater than TT-TG value(0.886),and diagnostic parameters were 13.84 ånd 14.69 mm,respectively;in tibial osteotomy,the area under ROC curve of external deviation angle of patellar tendon was 0.821,and osteotomy parameter was 20.15°.
Conclusion: CT imaging could reliably measure external deviation angle of patellar tendon.There is a strong positive correlation between external deviation angle of patellar tendon and value of TT-TG,which could be used to determine pathological state of recurrent patellar dislocation,and external deviation angle of patellar tendon is superior to the TT-TG value in the diagnosis of recurrent patellar dislocation. The external deviation angle of patellar tendon could also be used to guide the formulation of the tibial osteotomy plan for recurrent patellar dislocation. |
| KEY WORDS Patellar dislocation|Recurrence|Patellar ligament |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李健,戴祝,廖瑛,吴彪,刘全辉.髌腱外偏角的测量及在复发性髌骨脱位诊断中的应用[J].中国骨伤,2022,35(6):532~537 |
| 英文格式: | LI Jian,DAI Zhu,LIAO Ying,WU Biao,LIU Quan-hui.Measurement of external deviation angle of patellar tendon and its application on diagnosis of recurrent patellar dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(6):532~537 |
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