急性髌骨外侧脱位患者性别、年龄、解剖参数与髌股关节软骨损伤的相关性

Correlations between gender,age,anatomic parameters and articular cartilage lesions of patellofemoral joints after acute lateral patella dislocation

目的探讨急性髌骨外侧脱位(lateral patellar dislocation,LPD)患者性别、年龄、髌股关节解剖参数与髌股关节软骨损伤的相关性。方法回顾性分析2015-01至2021-07在武警山东总队医院就诊的115例经临床证实为急性LPD患者的MRI资料,对患者性别、年龄[分为青少年(<18岁)、成人(≥18岁)]、髌股关节解剖参数[髌骨位置、胫骨结节-股骨滑车沟(tibial tubercle-trochlear groove,TT-TG)间距、股骨滑车类型]与急性LPD后髌骨、股骨外侧髁关节损伤的相关性进行统计学分析。结果急性LPD后,髌骨、股骨外侧髁关节软骨损伤发生率分别为46.1%、27.0%。男性、女性髌骨关节软骨损伤发生率分别为58.7%、37.7%,股骨外侧髁关节软骨损伤发生率分别为34.8%、21.7%,两组比较,髌股关节软骨损伤发生率差异有统计学意义(χ^(2)=4.905,P=0.027)。成人组、青少年组髌骨关节软骨损伤发生率分别为57.1%、37.9%,股骨外侧髁关节软骨损伤发生率分别为36.7%、19.7%,两组比较差异均有统计学意义(χ^(2)=4.200,P=0.040;χ^(2)=4.156,P=0.042)。TT-TG间距正常、TT-TG间距过大者髌骨关节软骨损伤发生率分别为52.6%、32.4%,股骨外侧髁关节软骨损伤发生率分别为32.1%、16.2%,两组比较,髌骨关节软骨损伤发生率差异有统计学意义(χ^(2)=4.093,P=0.043)。股骨滑车发育正常、股骨滑车重度发育不良者髌骨关节软骨损伤发生率分别为58.7%、28.6%,股骨外侧髁关节软骨损伤发生率分别为39.1%、14.3%,两组比较差异均有统计学意义(χ^(2)=7.269,P=0.007;χ^(2)=6.034,P=0.014)。髌骨位置正常、髌骨高位者髌骨关节软骨损伤发生率分别为48.4%、43.4%,股骨外侧髁关节软骨损伤发生率分别为30.6%、22.6%,两组比较差异均无统计学意义(χ^(2)=0.286,P=0.593;χ^(2)=0.93,P=0.335)。结论急性LPD后,成人、股骨滑车发育正常者更易于发生髌骨和股骨外侧髁的关节软骨损伤,男性、TT-TG间距正常者更易于发生髌骨关节软骨损伤。

Objective To study the correlations between gender,age,patellofemoral anatomic parameters and patellofemoral cartilage lesions after acute lateral patellar dislocation(LPD).Methods Between January 2015 and July 2021,the MRI data on 115 patients with clinically proved acute LPD treated in Shandong Provincial Corps Hospital of Chinese People’s Armed Police Force was retrospectively analyzed.The correlations between gender,age(adolescents(<18 years)and adults(≥18 years)),patellofemoral anatomic parameters(patellar height,tibial tuberosity–trochlear groove(TT-TG)distance and trochlear dysplasia)and articular cartilage lesions of the patella and lateral femoral condyle were statistically analyzed.Results The incidence of articular cartilage lesions of the patella and lateral femoral condyle was 46.1%and 27.0%after acute LPD,respectively.The incidence of articular cartilage lesions of the patella in the male group and female group was 58.7%and 37.7%respectively,compared with 34.8%and 21.7%for the lateral femoral condyle.There was significant difference in the incidence of articular cartilage lesions of the patella between the male and female groups(χ^(2)=4.905,P=0.027).The incidence of articular cartilage lesions of the patella in the adult group and adolescent group was 57.1%and 37.9%respectively,compared with 36.7%and 19.7%for the lateral femoral condyle.There was significant difference in the incidence of articular cartilage lesions of the patella and lateral femoral condyle between the adult group and the adolescent group(χ^(2)=4.2,P=0.04;χ^(2)=4.156,P=0.042).The incidence of articular cartilage lesions of the patella was 52.6%and 32.4%respectively in the normal TT-TG distance group and elevated TT-TG distance group,compared with 32.1%and 16.2%for the lateral femoral condyle.There was significant difference in the incidence of articular cartilage lesions of the patella between the normal and elevated TT-TG distance groups(χ^(2)=4.093,P=0.043).The incidence of articular cartilage lesions of the patella in the normal trochlea group and high-grade trochlear dysplasia group was 58.7%and 28.6%respectively,and that of the lateral femoral condyle was 39.1%and 14.3%respectively.There was significant difference in the incidence of articular cartilage lesions of the patella and lateral femoral condyle between the normal trochlea and high-grade trochlear dysplasia groups(χ^(2)=7.269,P=0.007;χ^(2)=6.034,P=0.014).The incidence of articular cartilage lesions of the patella in the normal patellar height group and patella alta group was 48.4%and 43.4%respectively,compared with 30.6%and 22.6%for the lateral femoral condyle.Conclusions Adults and patients with normal trochlea are more vulnerable to articular cartilage lesions of the patella and lateral femoral condyle after acute LPD.Males and patients with normal TT-TG distance are more vulnerable to articular cartilage lesions of the patella after acute LPD.