复发性髌骨脱位术后膝关节CT表现与临床功能的相关性分析

Correlation Analysis between the CT Manifestations and Clinical Function of Knee Joint after Recurrent Patellar Dislocation Surgery

目的观察复发性髌骨脱位三联术后中长期随访过程中,膝关节的CT表现及其与膝关节功能评分之间的关系。方法选取26例(27膝)确诊为复发性髌骨脱位并行髌骨脱位三联术(内侧髌股韧带重组术、外侧髌骨支持带松解术与胫骨结节移位术)的患者为研究对象,比较术后短期(1~2年)及中长期(5年以上)CT测量值的变化,并与膝关节功能评分进行相关性分析。结果髌骨脱位三联术后短期与术前相比,Insall-Salvati指数(ISI)及胫骨结节-股骨滑车沟(TT-TG)距离均明显减小,差异有统计学意义(P<0.05)。术后短期与术后3天相比,股骨及髌骨隧道宽度扩大,滑车沟适合角(CA)、髌骨倾斜角(PTA)及髌骨外侧移位值(LPD)均增大,外侧髌股角(LPA)减小;术后中长期与术后3天相比,除以上改变外,ISI明显减小;术后中长期与术后短期相比,PTA增大,LPA减小,以上差异均有统计学意义(P<0.05)。术后中长期平均Kujala评分与Lysholm评分较短期均提高,其中Kujula评分差异有统计学意义(P=0.001)。术后中长期随访中,股骨滑车发育不良Dejour分型越高级,Kujala评分越低。结论髌骨脱位三联术后可通过CT检查随访膝关节术后影像学改变,通过各CT参数与临床功能评分的相关性研究可以评估膝关节功能恢复的影响因素。

Objective To observe the CT manifestations of the knee and their relationship with knee function scores during the medium to long term follow-up after patellar dislocation triple surgery.Methods 26 patients(27 knees)were admitted from January 2008 to December 2019 who had undergone patellar dislocation triple surgery(medial patellofemoral ligament reconstruction,lateral patellar retinaculum release and tibial tubercle displacement).All patients were followed up for more than 5 years and had undergone CT examination and knee function scores in 1-2 years and more than 5 years after operation.All patients in the study underwent CT examination before and 3 days after operation.Radiological measurements on CT included femoral and patellar tunnel width,lateral patellar displacement(LPD),patellar tilt angle(PTA),congruence angle(CA),lateral patellofemoral angle(LPA),tibial tubercle trochlear groove distance(TT-TG),Insall-Salvati Index(ISI)and degree of trochlear dysplasia.The changes of CT measurements were compared.The correlation between the last CT manifestations and the knee function scores was analyzed.Results The Insall Salvati Index and TT TG decreased significantly in the short term after triple surgery compared with that before operation.Compared with 3 days after operation,the femoral and patellar tunnel width,CA,PTA and LPD all increased,while LPA decreased in the short term follow-up.In addition to the above changes,the Insall Salvati Index decreased significantly in the medium to long term follow-up compared with 3 days after operation.The PTA increased while LPA decreased compared with those of short term follow-up.The Kujala score and Lysholm score were higher than those in the short term follow-up.The difference of kujala score was statistically significant(P=0.001).In the medium to long term follow-up,the severity of femoral trochlear dysplasia was negatively correlated with the Kujala score.Conclusion The imaging changes of the knee joint after triple operation of patellar dislocation can be followed up by Computed Tomography.The factors affecting the functional recovery of the knee joint can be evaluated by the correlation study between CT parameters and the knee function scores.