髌骨高度的测量及高位髌骨的研究进展

Measurement of patella height and advance of patella alta

背景:随着运动医学的不断发展以及对髌股关节疾病的深入研究,高位髌骨作为髌股关节病的重要发病因素被越来越多的研究,其影像学测量指标众多,广大临床医生和影像学工作者尝试早期诊断和治疗这一重要疾病。目的:对高位髌骨的影像学诊断及最新进展进行综述,指出各个指标的优点和局限性,为下一步研究拓宽思路。方法:应用计算机检索1989至2013年中国知网及Pubmed数据库,关于髌骨高度测量、高位髌骨的影像学诊断方面的文献报道,并对不同的诊断指标进行归纳综述。中文检索词为"高位髌骨、髌骨高度、髌骨位置、诊断、测量",英文检索词为"patella alta,patella height,measurement,diagnosis"。结果与结论:目前临床上常用的评估髌骨高度的指标很多,主要被分为两类:一类是间接指标,评估髌骨与胫骨之间的位置关系,比如经典的Insall-Salvat(IS)指数,Blackburne-Peel(BP)指数,和Caton-Deschamps(CD)指数。另一类是直接指标,评估髌骨与股骨之间的关系。包括等"The patellotrochlear index","The patellophyseal index"等。现在认为,髌股关节的生物力学是阐明髌骨关节紊乱疾病基础的关键。随着MRI技术的推广,直接评估髌股关节关节软骨面位置关系的指标如髌骨滑车指数被认为反映髌股关节的实际匹配状况的最佳指标。但对于髌骨滑车指数的研究同样有不少问题等待解决。

BACKGROUND：With the development of sports medicine and research of patel ofemoral disorder, patel a alta has been paid increasing attention as the exact pathogenesis of patel ofemoral disorder. There are many radiographic measurement indexes of patel a alta. A large number of clinicians and radiography physicians are trying to diagnose and treat this disease as early as possible. OBJECTIVE：To review the radiographic measurement and research progress of patel a alta, find out the advantages and disadvantages of different indexes, and look into the future development prospects. METHODS：A computer-based online search of Pubmed and CNKI databases between 1989 and 2013 was performed for articles addressing radiographic diagnose and measurement patel a alta. The key words were“patel a alta, patel a height, measurement, diagnosis”in English and“patel a alta, patel a height, patel a position, diagnosis, measurement”in Chinese. RESULTS AND CONCLUSION：Now there are many measurement indexes of patel a alta and they are divided into two groups：indirect index and direct index. The indirect index measures the relative location of patel a and tibia, such as Insal-Salvat index, Blackburne-Peel index, and Caton-Deschamps index. The direct index measures the relative location of patel a and femur, such as patel otrochlear index, and patel ophyseal index. The latest study indicates that the biomechanics of patel ofemoral joint is the key to understand the pathogenesis of patel ofemoral disorder. As the MRI technique develops, direct index for the location of articular cartilage of＆nbsp;patel ofemoral joint, such as patel otrochlear index, seems to be the best measurement to patel a alta. However we stil have many problems in the study of patel otrochlear index.