青少年急性外伤性髌骨外侧脱位MRI测量与分析

MRI analysis of acute traumatic lateral patella dislocation in adolescents

目的探讨青少年急性外伤性髌骨外侧脱位(acute traumatic lateral patellaur dislocation,ATLPD)患儿的MRI影像学表现。方法回顾性分析89例经手术证实的青少年急性外伤性髌骨外侧脱位患儿的临床及影像学表现,并结合临床及关节镜相关资料,总结患者影像学特征。使用Insall-Salvati index(ISI)、The patellotrochlear index(PTI)以及Caton-Deschamps index三种测量方法对32例经手术证实的青少年急性外伤性髌骨外侧脱位患儿的患侧与健侧髌骨高度进行测量。结果MRI显示89例患儿均存在关节腔积液、髌骨内下缘和股骨外侧髁骨髓水肿。81(91%)例骨软骨损伤,髌骨侧27例(33.3%)、股骨侧13例(16.1%)、髌骨-股骨骨软骨损伤41例(50.6%),其中关节内游离体58例(71.6%)。89例中内侧髌股韧带撕裂78例(92.1%),韧带变薄11例(7.9%)。23例患儿患侧与健侧髌骨高度分别使用三种方法测量,ISI患侧与健侧髌骨高度分别为(1.13±0.03)、(1.24±0.04);PTI患侧与健侧髌骨高度分别为(0.41±0.02)、(0.42±0.02);CDI患侧与健侧髌骨高度分别为(1.23±0.03)、(1.29±0.02)。三种测量方法P值均>0.05,患侧与健侧髌骨高度差异无统计学意义。结论MRI能准确地显示各解剖结构的损伤及程度,为临床诊断及治疗方式的选择提供依据。发生ATLPD的患儿,患侧髌骨高度与健侧髌骨高度差异不大,为临床诊断及治疗方式的选择提供依据。

Objective To explore the MRI imaging findings in adolescents with acute traumatic lateral patellaur(ATLPD). Methods The clinical and imaging features of Eighty-nine children with surgically confirmed acute traumatic lateral dislocation of patella were retrospectively analyzed, and the imaging features of the patients were summarized combined with the clinical and arthroscopic data.Use The Insall-Salvati index(ISI),The patellotrochlear index(PTI),and Caton-Deschamps index Three methods were used to measure the height of the affected and healthy patella in thirty-two children with surgically confirmed acute traumatic lateral dislocation of patella. Results MRI showed that all eighty-nine patients had joint effusion and bone marrow edema at the medial and inferior margin of patella and lateral condyle of femur.Eighty-one cases(91%) suffered osteochondral injury, twenty-seven cases(33.3%) of patella side, thirteen cases(16.1%) of femur side, forty-one cases(50.6%) of patella-femur osteochondral injury, including fifty-eight cases(71.6%) of intrarticular loose body.The medial patellofemoral ligament was torn in seventy-eight cases(92.1%) and thinned in eleven cases(7.9%).Three methods were used to measure the patellar height of the affected side and the healthy side respectively in twenty-three cases.The patellar height of the affected side and the healthy side of ISI were( 1.13±0.03) and(1.24±0.04),respectively.The patellar height of the affected side and the healthy side of PTI were( 0.41±0.02) and(0.42±0.02)respectively.The patella heights of the affected side and the healthy side were( 1.23±0.03)and(1.29±0.02),respectively.The P values of the three measurement methods were all>0.05,and there was no statistical significance in the height of patella between the affected side and the healthy side. Conclusion MRI can accurately show the damage and degree of each anatomical structure, which can provide the basis for clinical diagnosis and treatment.In children with ATLPD,there is little difference between the patellar height of the affected side and that of the healthy side, which provides a basis for clinical diagnosis and treatment.