复发性髌骨脱位高度髌骨轨迹不良的发生率及危险因素分析

The Prevalence of High-grade Patellar Maltracking in Patients with Recurrent Patellar Dislocation and Its Risk Factors

目的:探讨复发性髌骨脱位患者伴有高度髌骨轨迹不良的发生率及危险因素。方法:从2017年1月至2018年8月连续诊断为复发性髌骨脱位的患者中选取符合纳入标准的患者共117名,根据膝关节0°伸直位时髌股关节的对合关系将髌骨轨迹分为3类:正常或接近正常、低度轨迹不良、高度轨迹不良,其中存在高度轨迹不良的患者为病例组,其余患者为对照组。测量Caton指数、Dejour分型、TT-TG和下肢旋转参数(股骨前倾角、胫骨外旋角及关节扭转角),比较上述参数在病例组和对照组中的差异,探究复发性髌骨脱位患者出现高度髌骨轨迹不良的危险因素。结果:本研究中,复发性髌骨脱位伴高度髌骨轨迹不良的发生率为21.4%(25/117);单因素分析显示病例组的股骨前倾角、关节扭转角和高位髌骨发生率大于对照组,差异具有统计学意义(P<0.05);多因素Logistic回归分析结果显示股骨前倾角增大、关节扭转角增大和高位髌骨是复发性髌骨脱位患者出现高度髌骨轨迹不良的危险因素。结论:在本研究所涉及的复发性髌骨脱位患者中,高度髌骨轨迹不良的发生率为21.4%(25/117);股骨前倾角增大、关节扭转角增大以及高位髌骨可能是复发性髌骨脱位患者出现高度髌骨轨迹不良的危险因素。

Objective To investigate the prevalence and risk factors of the high-grade patellar maltracking in patients with recurrent patellar dislocation. Methods A total of 117 recurrent patellar dislocation patients admitted between January 2017 and August 2018 were selected and divided into three categories according to patellofemoral congruence with the knee in full extension: the normal or nearly normal,low-grade patellar maltracking,and high-grade maltracking. Patients with the high-grade patellar maltracking were chosen into the study group, and the other patients were controls. The Caton index, Dejour classification, tibia tubercle-trochlear groove and rotational parameters of the lower extremity including the femoral anteversion angle,external tibial torsion angle and knee joint torsion angle were assessed and compared between the two groups. Moreover,the risk factors of the high-grade patellar maltracking in recurrent patellar dislocation patients were analyzed. Results The prevalence of the high-grade patellar maltracking in patients with recurrent patellar dislocation was 21.4%(25/117). Univarite analysis results showed that the femoral anteversion angle,knee joint torsion angle and prevalence of patellar alta of the study group were significantly higher than the control group. Multivariable logistic regressions indicated that the increased femoral anteversion,enlarged knee joint torsion angle and patellar alta were risk factors of the high-grade patellar maltracking in patients with the recurrent patellar dislocation. Conclusion The prevalence of high-grade patellar maltracking among these included recurrent patellar dislocation patients was 21.4%(25/117). The increased femoral anteversion angle,enlarged knee joint torsion angle and patellar alta were strongly associated with the high-grade patellar maltracking in such patients.