CT在评估髌股关节异常对合中的应用

Evaluation of CT in the investigation of patellofemaral malajignment

目的探讨髌股关节异常对合的CT评价价值。方法收集经关节镜检查的49例60侧膝髌股关节异常对合患者（疾病组）及15例30侧膝髌股关节无症状者（健康对照组）的CT资料；痰病组依据关节镜的检查结果，按髌软骨的损伤程度分为疾病早期组（疾病A组）和疾病晚期组（疾病B组），疾病A组和疾病B组髌股关节各30个；在屈膝30。时对髌股关节行CT横断扫描，分别测量并比较分析各组髁间沟角、和谐角、外侧髌股角等角度参数，观察CT征象。结果疾病A组及疾病B组髌股关节的和谐角明显大于对照组，外侧髌股角明显小于健康对照组（P〈0．01）；疾病A组与疾病B组髌股关节的和谐角及外侧髌股角差异无统计学意义（P〉0．05）；健康对照组与疾病组两组之间，髁间沟角差异无统计学意义（P〉0．05）；CT骨窗观察到软骨下骨质硬化、小囊样变、关节边缘骨赘增生或关节间隙狭窄等表现疾病A组2个（6.7％），疾病B组9个（30．0％）。结论测量和谐角、外侧髌股角比观察CT征象能更早期、更客观反映髌股关节异常对合，但不能区分髌软骨的损伤程度或病变的分期。

Objective To evaluate the value of CT in investigating patellofemaral malajignment. Methods Disease group included 49 patients（60 knees） with patellofemaral malajignment and control group included 15 asymptomatic volunteers（30 knees） were studied, all patients（60 knees） were examined by arthroscopy, there were 30 knees in early stage（group A） and 30 knees in late stage（group B） according to the lesion of cartilage of patella under arthroscopy, all patellofemarals were examined by CT scan at 30° flexion,some parameters included sulcus angle, congruence angle and lateral patellofemaral angle were analyzed comparatively. Results The congruence angle in group A and in group B was significant bigger than those in control group and the lateral patellofemaral angle was smaller than those in control group significant（ P 〈 0.01 ）, but the congruence angle and the lateral patellofemaral were no difference in statistics between group A and group B（P 〉0.05）,and the sulcus angle was no difference in statistics between disease group and control group （ P 〉 0.05 ）. CT finds subchondral bone sclerosis or periarticular hyperostosis or narrowed space of article in 2 knees in the group A,while 9 knees were found in the group B. Conclusion Congruence angle and lateral patellofemaral angle are the important parameters in early diagnosis of patellofemaral malajignment and more object than CT feature, but they can not discriminate the degree of the lesion of cartilage as well as the stage of disease.