MR定量测量指标在青少年髌骨不稳中的诊断应用价值

Diagnostic value of MR quantitative measurement indexes in patellar instability in adolescents

目的分析磁共振(MR)定量测量指标在青少年髌骨不稳中的诊断应用价值。方法选取2016年6月～2018年5月新疆医科大学第二附属医院骨科收治的48例(48膝)青少年髌骨不稳患者(病例组)和30例入院体检及招募的健康青少年志愿者(对照组)作为研究对象,两组均接受膝关节MR平扫,在横断面抑脂FSE PDWI上测量相关定量指标,包括髌骨偏移指数、髌骨倾斜角、髌骨外移度、滑车沟角度、股骨外侧滑车倾斜角及胫骨结节-滑车间距(TT-TG),并采用受试者工作曲线(ROC)分析各指标对髌股关节不稳的诊断效能。结果与对照组比较,病例组髌骨偏移指数、髌骨倾斜角、髌骨外移度、滑车沟角度及TT-TG明显增大,股骨外侧滑车倾斜角明显减小,差异有统计学意义(P <0.05)。女性青少年髌骨不稳患者髌骨偏移指数、髌骨倾斜角、髌骨外移度、滑车沟角度均大于男性青少年髌骨不稳患者,差异有统计学意义(P <0.05);不同性别青少年髌骨不稳患者股骨外侧滑车倾斜角、TT-TG比较,差异无统计学意义(P> 0.05)。MR各定量测量指标中,髌骨偏移指数、髌骨倾斜角、髌骨外移度、滑车沟角度、股骨外侧滑车倾斜角、TT-TG的ROC曲线下面积均>0.9,诊断青少年髌骨不稳的敏感度、特异度均>85%。结论伸膝状态下,MR定量测量的髌股关节指标对青少年髌骨不稳有较高的诊断效能,其中髌骨偏移指数、髌骨倾斜角、髌骨外移度、滑车沟角度存在性别差异,对不同性别青少年髌骨不稳的病情评估有一定的指导意义。

Objective To analyze the diagnostic value of magnetic resonance(MR)quantitative measurement indexes in patellar instability in adolescents.Methods Forty-eight cases(48knees)of adolescent patients with patellar instability(case group)treated in Department of Orthopedics of the Second Affiliated Hospital of Xinjiang Medical University and30cases of healthy young volunteers for health check-ups and recruitment(control group)from June2016to May2018were selected as research objects.They were given MR plain scan for knee joint.Related quantitative indexes were measured on cross-sectional fat-reducing FSE PDWI,including patellar deviation index,patellar tilt angle,patellar external displacement,trochlear groove angle,lateral femoral trochlear tilt angle,and tibial tuberosity-trochlear groove distance(TT-TG).And the receiver operating curve(ROC)was used to analyze the diagnostic efficacy of indexes for patellofemoral joint instability.Results Compared with control group,the patellar deviation index,patellar tilt angle,patellar external displacement,trochlear groove angle and TT-TG in case group were significantly larger,and the lateral femoral trochlear tilt angle was significantly smaller,the differences were statistically significant(P<0.05).The patellar deviation index,patellar tilt angle,patellar external displacement and trochlear groove angle of female adolescent patients with patellar instability were lager than those of male adolescent patients with patellar instability,the differences were statistically significant(P<0.05).And there was no significant difference between male and female adolescents with patellar instability in lateral femoral trochlear tilt angle and TT-TG(P<0.05).Among MR quantitative measurement indexes,the areas under the ROC curve of patellar deviation index,patellar tilt angle,patellar external displacement,trochlear groove angle,lateral femoral trochlear tilt angle and TT-TG were all>0.9,and the sensitivity and specificity of diagnosing patellar instability in adolescents were all>85%.Conclusion In the state of knee extension,MR quantitative measurement of patellofemoral joint indexes have a high diagnostic efficiency for patellar instability in adolescents.There are gender differences in the patellar deviation index,patellar tilt angle,patellar external displacement and trochlear groove angle,which has a certain guiding role in the assessment of patellar instability in adolescents with different gender.