髌骨高度测量常用4种方法的运用与比较

Application and comparison of four commonly used methods for patellar height measurement

背景:胫骨高位截骨是近年来较为盛行的用于治疗膝内侧间室骨关节炎的保膝手术之一,但先前文献报道该术式对髌骨高度的影响不一,其主要原因是采用了不同的髌骨高度测量方法。目的:综合评价胫骨高位截骨前后Caton-Deschamps指数、Blackburne-Peel指数、Insall-Salvati指数和改良Insall-Salvati指数的一致性和可重复性。方法:回顾性分析收集了广州中医药大学第一附属医院关节外科2014年2月至2017年12月影像学资料完整、采用内侧开放楔形的双平面胫骨高位截骨治疗内侧膝关节骨性关节炎的患者31例(34膝)。选取治疗前治疗后屈膝30°的膝关节侧位片,由2名评价者独立地分别使用Caton-Deschamps指数、Blackburne-Peel指数、Insall-Salvati指数和改良Insall-Salvati指数测量治疗前以及治疗后的髌骨高度。试验于2019-11-06经广州中医药大学附属第一医院伦理委员会批准,批准号:K2019122。结果与结论:①治疗后Caton-Deschamps指数和Blackburne-Peel指数指数较治疗前明显降低,而治疗前和治疗后Insall-Salvati指数和改良Insall-Salvati指数差异无显著性意义;②一致性定量结果显示,治疗前Blackburne-Peel指数与Caton-Deschamps指数、改良Insall-Salvati指数与Caton-Deschamps指数、改良Insall-Salvati指数与Blackburne-Peel指数的一致性良好,而治疗后只有Blackburne-Peel指数与Caton-Deschamps指数一致性良好;③一致性定性结果显示,治疗前后Blackburne-Peel指数与Caton-Deschamps指数的一致性良好;④治疗前观察者间一致性显示Blackburne-Peel指数一致性最高,Insall-Salvati指数指数次之,治疗后Blackburne-Peel指数和Caton-Deschamps指数一致性最好;⑤提示在髌骨高度测量方法的选择方面,推荐Blackburne-Peel指数作为胫骨高位外翻截骨治疗时髌骨高度最佳评估指数。

BACKGROUND:High tibial osteotomy is one of the more popular knee-preserving operations for the treatment of osteoarthritis of the medial compartment of the knee in recent years.However,the previous literature reported that this operation has different effects on the height of the patella.The main reason is that it uses different measurement methods of patellar height.OBJECTIVE:To assess the consistency and reproducibility of Caton-Deschamps,Blackburne-Peel,Insall-Salvati and modified Insall-Salvati indices before and after high tibial osteotomy.METHODS:Complete imaging data of 31 patients(34 knees)with medial knee osteoarthritis,who were treated with open-wedge biplane high tibial osteotomy in the Department of Joint Surgery,The First Affiliated Hospital of Guangzhou University of Chinese Medicine from February 2014 to December 2017,were retrospectively analyzed.The lateral films of the knee with 30°knee flexion were selected before and after treatment.Patellar height was independently measured using Caton-Deschamps,Blackburne-Peel,Insall-Salvati and modified Insall-Salvati indices before and after treatment by two researchers.This trial was approved by the Ethics Committee of The First Affiliated Hospital of Guangzhou University of Chinese Medicine on November 6,2019(approval No.K2019122).RESULTS AND CONCLUSION:(1)Caton-Deschamps and Blackburne-Peel indices significantly decreased after treatment compared with preoperative indices.Insall-Salvati and modified Insall-Salvati indices were not significantly different before and after treatment.(2)Quantitative results of consistency showed that the consistency was good between Blackburne-Peel and Caton-Deschamps indices,modified Insall-Salvati and Caton-Deschamps indices,and modified Insall-Salvati and Blackburne-Peel indices before treatment.However,only Blackburne-Peel and Caton-Deschamps indices had good consistency after treatment.(3)Qualitative results of consistency displayed good consistency between Blackburne-Peel and Caton-Deschamps indices before and after treatment.(4)Interobserver consistency displayed highest consistency of Blackburne-Peel index,followed by Insall-Salvati index before treatment;and highest consistency between Blackburne-Peel and Caton-Deschamps indices after treatment.(5)It is indicated that regarding the choice of measurement methods of patellar height,Blackburne-Peel index is recommended as the best evaluation index of patellar height in the treatment of high tibial valgus osteotomy.