髌股疼痛综合征患者髌骨运动轨迹的动态CT研究

The dynamic CT measurement of patellar tracking with patellofemoral pain syndrome

目的 应用320排动态容积CT描述髌股疼痛综合征患者在膝关节屈曲运动中的动态髌骨轨迹,为髌股疼痛综合征的临床诊断及治疗方案的选择提供理论依据.方法 随机选择济南军区总医院2010年3月～2011年2月间资料完整确诊髌股疼痛综合征的女性患者24例（32膝）为实验组,年龄18～46岁,平均年龄31.1岁；随机选择健康女性13例（26膝）为对照组,年龄19～45岁,平均年龄32.1岁.应用320排动态容积CT检查：股四头肌等长收缩状态下自主屈曲膝关节,在膝关节屈曲0°～120°范围内间隔15°依次垂直髌骨进行动态CT扫描.应用Vitrea 2.1软件进行图像后处理,获得膝关节三维重建图像,测量髌骨运动轨迹参数：髌骨倾斜、髌骨移位和髌骨旋转.所有计数资料以均数和标准差描述,应用SPSS 16.0软件进行两样本均数t检验,P≤0.05有显著性意义.结果 15°～45°范围内两组的髌骨倾斜有显著性差异,P＜0.001；膝关节屈曲15°～45 °范围内两组的髌骨中心外移有显著性差异,P＜0.001；15°～120°范围内两组的髌骨旋转有显著性差异,P＜0.001.结论 膝关节屈曲15°～45°范围内髌股疼痛综合征患者的髌骨轨迹最具临床诊断、治疗意义.

Objective The purpose of this study was to investigate the dynamic patellar tracking patterns in symptomatic patients with patellofemoral pain syndrome by using 320-row dynamic volume computerized tomography during knee flexion. We hope these data may provide useful information for diagnosis and treatment in patellofemoral pain syndrome. Methods From Mar 2010 to Feb 2011, twenty-four female patients with patellofemoral pain syndrome in Jinan Military General Hospital were recruited in this study as experimental group by chance, in which eight patients had bilateral symptomatic knees. Their average age were 31.1 years （ranging from 18 to 46）, there were thirty-two symptomatic knees in experimental group. Thirteen healthy female volunteers were recruited in this study as control group randomly, with an average age of 32. 1 years （ranging from 19 to 45）. There were twenty-six asymptomatic knees in control group. Both groups were examined with 320-row dynamic volume computerized tomography scan at every 15° from 0° to 120° during knee flexion with quadriceps isometric contraction. Three-dimensional knee images were reconstructed by using Vitrea 2.1 software. Coordinate systems based on anatomical landmarks were established and the patellar tracking parameters （patellar tilt, patellar shift, patellar rotation） were measured in detail. Each variable was described by its mean and standard deviation at each target flexion angle, All the results were analyzed by using two group t-test, with a probability less than 0.05 regarded as significant. Results During 15°~45°knee flexion, there was significant difference in patellar shift between two groups （ P〈0. 001）. Significant difference in patellar rotation between two groups occurred during 15°~ 120° knee flexion （ P〈0. 001）. There was significant difference in patellar tilt between two groups during 15°~45°knee flexion （ P 〈0. 001）. Conclusion During 15°~45°knee flexion, the patellar tracking of patellofemoral pain syndrome contributes to clinical diagnosis and trement.