急性髌骨脱位MRI表现

MRI analysis of risk factors for acute patellar dislocation

目的探讨急性髌骨脱位的MRI表现。方法回顾性分析2015年1月—2016年12月四川省隆昌市人民医院诊治的56例急性髌骨脱位患者(APD组)的MRI资料,并选取同期MRI诊断为膝关节正常的52例志愿者作为健康对照组。对两组髌骨关节的MRI图像进行分析和比较,测量指标包括:髌骨高度(patellar height,PH)、股骨滑车沟角(sulcus angle,SA)、滑车沟深度(sulcus depth,SD)、滑车外侧面比例以及胫骨结节-股骨滑车凹间距(tibial tuberosity-trocholear distance,TT-TG)。结果通过MRI图像分析发现,与健康对照组比较,APD组的髌骨高度[(1.21±0.15)cm vs.(1.09±0.13)cm]、股骨滑车沟角[(152.68±8.29)°vs.(139.15±7.48)°]、胫骨结节-股骨滑车凹间距(TT-TG)距离[(1.57±0.28)cm vs.(1.26±0.19)cm]明显增加,而滑车沟深度[(0.45±0.06)cm vs.(0.56±0.04)cm]、股骨滑车外侧面比例[(0.52±0.09)%vs.(0.64±0.07)%]明显下降,差异均有统计学意义(P<0.01)。滑车发育不良Dejour分型结果中,APD组A、B、C、D型所占比重(32.14%、16.07%、8.93%、5.36%)明显高于健康对照组(15.38%、3.85%、0、0,P<0.05)。结论髌骨高位、TT-TG增大、股骨滑车沟角增大及股骨滑车外侧面比例、滑车沟深度减少是引发急性髌骨脱位的重要危险因素。MRI技术能够为其临床诊断、治疗方式选择以及治疗效果和预后提供有价值的信息。

Objective To investigate the performance of acute patellar dislocation by magnetic resonance imaging（ MRI）. Methods The MRI data of 56 patients with acute patellar dislocation（ APD group） diagnosed and treated from Jan. 2015 to Dec. 2016 in Longchang People＇s Hospital of Sichuan Province were analyzed retrospectively,and 52 volunteers with normal knee joint diagnosed by MRI at the same time were selected as control group. The MRI images of the two groups of patellar joints were analyzed and compared. Measured indexes included patellar height（ PH）,sulcus angle（ SA）,sulcus depth（ SD）,the depth of trochlear groove,the proportion of the lateral side of the femur and tibial tuberosity trocholear distance（ TT-TG）. Results MRI image analysis showed that compared with the control group,the patellar height（（ 1. 21 ± 0. 15） cm vs.（ 1. 09 ± 0. 13） cm）,femoral trochlear sulcus angle（（ 152. 68 ± 8. 29） ° vs.（ 139. 15 ± 7. 48） °） and TT-TG distance（（ 1. 57 ± 0. 28） cm vs.（ 1. 26 ±0. 19） cm） in APD group were significantly higher,the depth of trochlear groove（（ 0. 45 ± 0. 06） cm vs.（ 0. 56 ±0. 04） cm） and the proportion of the lateral side of the femur（（ 0. 52 ± 0. 09） % vs.（ 0. 64 ± 0. 07） %） were significantly lower（ P 0. 01）. In the Dejour classification of trochlear dysplasia,the proportion of type A,type B,type C and type D（ 32. 14%,16. 07%,8. 93%,5. 36%） in APD group was significantly higher than that（ 15. 38%,3. 85%,0,0） in the control group（ P 0. 05）. Conclusion High patella and TT-TG,increased femoral trochlear sulcus angle,reduction of the trochlear lateral portion of the femur and the trochlear groove depth may be important factors in the initiation of acute patellar dislocation. MRI technique can provide valuable information for clinical diagnosis,treatment options,treatment outcome and prognosis.