成年人高位髌骨的X线改变及临床分级

X-ray changes and clinical grading of patella alta in adults

目的 :观察成年人高位髌骨患者的X线改变 ,并根据X线改变进行临床分级 ,以估计预后和指导临床治疗。方法 :对临床诊断为高位髌骨的 18例成年患者 ,共计 34侧膝关节 ,进行屈膝 30°侧位片和髌骨轴位片的拍摄 ,然后在X片上测定Blumensaat距离、髌骨高度、股骨滑车沟角、髌股协调角、外侧髌股角、髌股指数、髌骨外移度七项参数 ,并与对照组进行比较。选用Blumensaat距离 ,髌骨高度及髌股协调角作为临床分级的参数指标。结果 :病例组与对照组比较 :Blumen saat距离 ,髌骨高度的差异有非常显著性意义 (P <0 .0 1) ;髌股协调角、外侧髌股角、髌股指数、髌骨外移度的差异有显著性意义 (P <0 .0 5 ) ;股骨滑车沟角的差异无显著性意义 (P >0 .0 5 )。临床分级 :10侧膝关节属轻度 ,表现为髌骨软骨软化症 ,药物疗效好 ;2 1侧属重度 ,表现为髌股关节骨关节炎 ,药物疗效差。结论 :成年人高位髌骨的X线改变以髌骨的异常高位为主 ,伴有一定程度的髌骨外移和向外侧倾斜 ,临床分级在定性诊断的基础上 ,融入了定量诊断 。

Objective:To observe the x-ray changes and make clinical grading of patella alta in adults.Methods:34 knees in 18 patients with patella alta were adopted in this study.The radiographic examination includes lateral view and axial view with the knee in 30° of flexion,Then Blumensaat's distance、patella height 、sulcus angle、congruence angle、lateral patellofemoral angle、patellofemoral index、lateral shift distance were measured and compared with that of the control group.Blumensaat's distance,patella height and congruence angle were also adopted to make the clinical grading.Results:[WT5”BZ]There is very significant difference in Blumensaat's distance、patella height(P<0.01)and significant difference in congruence angle,lateral patellofemoral angle,patellofemoral index,lateral shift distance(P<0.05).There is no significant difference in sulcus angle(P>0.05).Among the clinical grading,10 knees belong to the mild degree and 21 knees belong to the severe degree.Conclusion:The x-ray changes of patella alta in adults are characterised by the abnormal high position of patella mainly,accompanied by the lateral shift and tilt of patella.The method of clinical grading is worth of further studying.