股骨远端内侧扭转与髌股关节力线异常的相关性研究

Correlation study between femoral distal medial torsion and patellofemoral joint malalignment

目的探讨股骨远端内侧扭转与髌股关节力线异常的相关性，分析髌股关节紊乱症的致病因素，为临床治疗提供新的理论基础。方法2007年5月至2009年6月在门诊随机选取符合入选标准的髌股关节紊乱症患者95例（124膝），均行双膝关节屈膝20°～30°髌股关节动力性CT扫描。测量股骨远端内侧扭转角（FMTA）、髌骨适合角（CA）、髌骨倾斜角（PTA）。然后将FMTA、CA、PTA绘制成散点图进行直线相关性分析。结果124膝中有25膝FMTA〈5°，99膝FMTA／〉5°，其中6膝股骨滑车发育不良将其排除。余下93膝FMTA16．06°±5．68°，CA16．40°±5．48°，PTA19．590±3．32°。通过散点图分析结果显示，当FMTA〉10°时，FMTA与CA呈正相关（r=0．709，P〈0．05）；FMTA与PTA呈正相关（r=0．652，P〈0．05），但是当FMTA〉27°时，这种相关趋势减弱。结论股骨远端内侧扭转是导致髌股关节力线异常的重要原因，当FMTA〉10°时，FMTA与CA呈正相关；FMTA与PTA呈正相关，但是当FMTA〉27°时，这种相关趋势减弱。

Objective To investigate the correlation between femoral distal medial torsion and patellofemoral joint malalignment and analyze the causes of patellofemoral joint disorders, which provide the new theory with clinical treatment. Methods From May 2007 to June 2009,124 knees （95 cases） with patellofemoral joint disorders were enrolled in this study randomly. Each knee was scanned with CT in dynamic 20° -30° knee flax position. Femoral distal medial torsion angle （FMTA）, patellar congruence angle （CA） and patellar tht angle （PTA） were measured. The correlation between FMTA and CA or PTA was analyzed. Results FMTA 〈 5° in 25 knees,≥5° in 99 knees, 6 knees with trochlear dysplasia who were excluded. FMTA in 93 knees was 16.06°± 5.68° , CA was 16.40°± 5.48° and PTA was 19.59° ± 3.32°. The positive correlation was found between FMTA and CA when FMTA 〉 10° through scatter diagram analysis （r = 0.709,P 〈 0.05）. The positive correlation was found between FMTA and PTA when FMTA 〉 10° （r = 0.652,P 〈 0.05）,the positive trend declined when FMTA 〉 27°. Conclusions Femoral distal medial torsion is an important risk factor of patellofemoral joint malalignment. When FMTA 〉 10° ,FMTA and CA, PTA has positive correlation, but the positive trend between FMTA and PTA declines when FMTA 〉 27°.