膝前痛与下肢扭转畸形的相关性研究

Does anterior knee pain relate to the lower extremity axial alignment? A case-control study

目的探讨膝前痛与股骨和胫骨水平面扭转畸形的相关性。方法前瞻性分析2017年3—6月解放军第四〇一医院骨科患者40例,分为病例组和对照组。其中病例组包括膝前痛患者20例(31膝),男7例(8膝),女13例(23膝),年龄(26.1±7.8)(18~35)岁;对照组包括无膝前痛的膝关节滑膜炎或半月板损伤患者20例(40膝),男8例(16膝),女12例(24膝),年龄(28.0±8.1)(19~35)岁。测量指标包括髋关节内旋角、大腿足夹角(TFA)、股骨前倾角和胫骨外旋角。比较2组间各项指标的差异。采用SPSS 22.0软件对数据进行统计学处理。结果病例组与对照组年龄和性别分布差异无统计学意义。病例组髋关节内旋角为73.2°,TFA为22.9°,股骨前倾角为27.9°,胫骨外旋角为37.9°;对照组髋关节内旋角为43.3°,TFA为14.8°,股骨前倾角为11.3°,胫骨外旋角为21.9°。2组间各项测量指标差异均有统计学意义(P=0.000)。结论膝前痛与下肢水平面扭转畸形有相关性。体格检查测量髋关节内旋角和TFA可以初步筛查下肢扭转畸形,结合CT测量股骨前倾角和胫骨外旋角,可为临床去旋转截骨手术干预决策提供参考和依据。

Objective To investigate the correlation of anterior knee pain and lower extremity axial alignment. Methods From March to June 2017,20 cases （31 knees） with anterior knee pain aged 18-35 years, were included as case group. During the same period, 20 cases （40 knees） without anterior knee pain who consulted for meniscal injury or mild synovitis were selected as control. By physical examination, hip joint internal rotation angle and thigh foot angle were measured for clinic screening. Femoral anteversion angle and tibial external rotation angle were measured by poly-planar axial CT to define axial alignment precisely. The da-ta for the 2 groups were compared and analyzed by SPSS 22.0. Results In case group, the hip joint internal rotation angle and thigh foot angle were 73.2° and 22.9° , respectively, while those of control group were 43.3° and 14. 8° ,and the differences between 2 groups were statistically significant（P =0. 000）. By poly-planar axial CT measurement, the femoral anteversion angle and tibial external rotation angle in case group were 27. 9°and 37.9°, compared with those of control group （11. 3° and 2 1 .9 ° ） respectively, the differences were statistically significant. Conclusion There is a strong correlation between anterior knee pain and lower extremity axial alignment. The hip joint intemail rotation angle and thigh foot angle are useful to screen femoral and tibial torsion by physical examination, while poly-planar axial CT could measure femoral anteversion angle and tibial external rotation angle precisely, which are critical for surgical interference.