股骨滑车及髌骨发育不良的MRI表现及其临床意义分析

MRI findings of femoral trochlear and patellar dysplasia

目的探讨股骨滑车及髌骨发育不良的MRI表现及其与髌股关节紊乱症的相关性。方法膝关节病例组26例(30个膝)及对照组30例(30个膝)均行MRI检查,在股胫关节上方3 cm层面进行测量,对TT-TG间距、股骨滑车前上侧突起、内外侧滑车关节面比例、外侧倾斜角、髌骨Wiberg分型及指数进行定性及定量分析(注释:在观察的指标中,TT-TG间距、股骨滑车前上侧突起、内外侧滑车关节面比例、外侧倾斜角、髌骨Wiber指数为定量分析,髌骨Wiberg分型为定性分析)。结果两组别TT-TG间距(P=0.02)、滑车前上缘突起(P=0.00)、外侧倾斜角(P=0.00)、内外侧关节面比值(P=0.01)、髌骨Wiberg指数(P=0.00)的测量值差异均具有非常显著的统计学差异;WibergⅠ-Ⅱ型组与WibergⅢ-Ⅳ型组Wiberg指数的均值具有显著的统计学差异(P=0.00)。髌骨Wiberg指数与股骨滑车发育形态、髌骨Wiberg分型呈负相关;股骨滑车发育类型与髌骨分型呈正相关。结论股骨滑车与髌骨发育不良常常同时存在(P=0.00),成为髌股关节紊乱症的骨发育结构不良的直接原因。MRI横轴位对股骨滑车发育不良的诊断具有非常重要的价值,应纳入膝关节检查的常规扫描。

Objective To investigate the MRI findings of patellar and femoral trochlear dysplasia.Methods 30 knee MRI studies of 26 consecutive patients with patellofemoral disorders were reviewed and compared with 30 MRI examinations of 30 healthy volunteers.The tibial tubercle-trochlear groove distance（TT-TG）,ventral trochlear prominence,ratio of internal and external trochlear facets,lateral patellofemoral angle,Wiberg classification for patellar shape and Wiberg index were determined on the axial images at 3 cm above the femorotibial joint.Independent-samplet test with IBM SPSS 18.0 software package was used for statistical analysis.Results There were significant differences in the TT-TG（P=0.02）,ventral trochlear prominence（P=0）,lateral patellofemoral angle（P=0）,ratio of internal and external trochlear facets（P=0.01）,and patellar Wiberg indexes（P=0）between patellofemoral disorders and normal knees as well as between WibergⅠ-Ⅱand WibergⅢ-Ⅳ（P=0）.The patellar Wiberg indexes were inversely correlated with the trochlear and patellar shapes whereas the trochlear shapes were positively correlated with patellar shapes.Conclusion Axial MRI is useful for assessing patellar and femoral trochlear dysplasia.