胫骨扭转畸形与髌骨不稳

The Relationship Between Tibial Torsional Deformity and Patellofemoral Instability

目的通过分析髌股关节退变性关节病（ｐａｔｅｌｏｆｅｍｏｒａｌｄｅｇｅｎｅｒａｔｉｖｅａｒｔｈｒｏｓｉｓ，ＰＦＤＡ）患者的胫骨扭转畸形与髌股关节排列紊乱的关系，揭示胫骨扭转畸形诱发ＰＦＤＡ的可能机制。方法在ＰＦＤＡ患者９１膝和正常人２１膝的ＣＴ扫描片上测量胫骨扭转角、髌股和谐角和外侧髌股角，分析ＰＦＤＡ与胫骨扭转畸形、髌股关节排列的关系。进而将患者按扭转角大小分为过大畸形组、过小畸形组和正常组，分析扭转畸形与髌股关节排列紊乱、发病年龄间的关系。结果ＰＦＤＡ患者胫骨扭转角（２７．０°±９．６４°）远大于正常人群（２２．２°±３．８７°），差异有显著性意义（Ｐ＜０．０５），并具有较大的髌股和谐角（１２．３°±１４．０°对４．７°±７．３°）及较小的外侧髌股角（１０．５°±４．９°对１３．２°±４．３°）。扭转角过小者（１０／９１）、过大畸形者（４１／９１）的发病年龄远较正常大小者（４０／９１）为早，差异有显著性意义（Ｐ＜０．０５），且三者间的髌股和谐角差异有显著性意义。结论ＰＦＤＡ与胫骨扭转畸形关系密切。胫骨扭转畸形者多伴有髌股关节不稳，并使ＰＦＤＡ提前发生；ＣＴ检测髌股关节，既提供髌股关节排列的准确信息又反映?

PurposeTo investigate the relationship between tibial torsional deformity and patellofemoral alignment in the patients with patellofemoral degenerative arthrosis(PFDA), in order to verify the pathogenesis of PFDA caused by tibial torsional deformity. MethodsCT measurements of tibial torsion, patellofemoral congruence angle(CA), lateral patellofemoral angle (LPFA) were evaluated in 91 knees suffering from PFDA and in 21 normal knees. The patients were divided into 3 groups,normal torsion, increased torsion and decreased torsion, according to the CT findings. The relationship between tibial torsional deformity and the occurrence of PFDA,or patellofemoral malalignmemt were analysed. ResultsThe degree of tibial torsion in patients with PFDA was significantly greater than that in normal people(27.09.64versus 22.23.87, P< 0.05). The CA in the patients was significantly greater (12.314.0versus 4.77.3, P< 0.05) and the LPFA in the patients was significantly smaller(10.54.9versus 13.24.3, P< 0.05).As for the age of starting PFDA, the groups with the decreased and the increased data were significantly earlier than the normal torsion group. The CA among the three groups were different significantly. ConclusionPFDA had a close relationship with tibial torsional deformity which often associated with patellofemoral instability and made the PFDA occurred early. It provides a baseline information for the doctors to improve the prevention and treatment of degenerative arthrosis.