膝关节相关参数对早期髌骨软化症的诊断价值

Diagnostic value of knee joint parameters for early chondromalacia of patella

目的通过对膝关节相关参数进行测量分析,探讨这些参数对早期髌骨软化症的诊断价值。方法纳入自2013-07—2015-12确诊的127例髌骨软化症作为观察组,选取71例健康志愿者作为对照组。比较2组膝关节屈曲90°Q角、髌骨高度(Caton指数,PH)、股骨滑车沟角(FTA)、股骨滑车外侧面比例(SLFR)、髌骨适合角(PCA)、髌骨倾斜角(PTA),并对差异有统计学意义的参数进行ROC曲线分析。结果与对照组比较,观察组膝关节屈曲90°Q角、PH、PCA、PTA更大,SLFR更小,差异有统计学意义(P<0.05);但2组FTA差异无统计学意义(P>0.05)。ROC曲线分析结果显示,X线片与MRI测量的PH、PCA、PTA诊断髌骨软化症具有较高可信度,而膝关节屈曲90°Q角、SLFR诊断髌骨软化症的可信度一般。髌骨软化症X线片阳性检出率为30.7%(39/127),髌骨软化症MRI阳性检出率为81.1%(103/127);髌骨软化症MRI阳性检出率高于X线片,差异有统计学意义(P<0.05)。结论MRI检查对早期髌骨软化症的阳性检出率高于X线片,PH、PCA、PTA是辅助诊断早期髌骨软化症可靠的膝关节参数,而早期发现髌骨软化症并加以干预是延缓髌骨软化症进展的有效手段。

Objective To investigate the diagnostic value of knee-related parameters for the early chondromalacia patellae through measurement and analysis of such parameters.Methods One hundred and twenty seven cases of chondromalacia patellae diagnosed between July 2013 and December 2015 were included as the observation group,and 71 health volunteers were selected as the control group.The knee flexion 90°Q angle,patella height(Caton index,PH),femur trochlea angle(FTA),sulcus lateral facet ratio(SLFR),patellar congruence angle(PCA)and patellar tilt angle(PTA)of the two groups were compared,and ROC curve analysis was made on the parameters with statistically significant difference.Results The knee flexion 90°Q angle,PH,PCA and PTA of the observation group were statistically significant greater than those of the control group,while the SLFR of the observation group was statistically significant less than that of the control group(P<0.05);however,there was no statistically significant difference in the FTA between the two groups(P>0.05).The ROC curve analysis showed that the PH,PCA and PTA measured by X-ray and MRI had high reliability for diagnosis of chondromalacia patellae,while the knee flexion 90°Q angle and SLFR had general reliability for diagnosis of chondromalacia patellae.The positive rate of chondromalacia patellae by X-ray and MRI was 30.7%(39/127)and 81.1%(103/127)respectively;the positive rate of chondromalacia patellae by MRI was statistically significant higher than that by X-ray(P<0.05).Conclusion The positive rate of early chondromalacia patellae by MRI is higher than that by X-ray,PH,PCA and PTA are reliable knee parameters for auxiliary diagnosis of early chondromalacia patellae,and early detection of chondromalacia patellae with intervention is effective to delay the progression of chondromalacia patellae.