【摘要】：目的:探討復(fù)發(fā)性髕骨不穩(wěn)的MR定量測(cè)量指標(biāo)在不同性別和年齡段中的差異性及其相應(yīng)的診斷價(jià)值。方法:將54例(58例患膝)經(jīng)保守治療失敗的臨床確診為復(fù)發(fā)性髕骨不穩(wěn)的患者作為髕骨不穩(wěn)組,另收集53例(53例健膝)無(wú)膝關(guān)節(jié)疼痛、外傷等不適癥狀的健康人群作為對(duì)照組,進(jìn)行回顧性MRI圖像分析。測(cè)量指標(biāo)包括:髕骨偏移指數(shù)、髕骨傾斜角、滑車(chē)溝角度、股骨外側(cè)滑車(chē)傾斜角、ISR及脛骨結(jié)節(jié)-股骨滑車(chē)溝距離(TT-TG)共6個(gè)指標(biāo)。采用MannWhitney U檢驗(yàn)或獨(dú)立樣本t檢驗(yàn)分別比較各測(cè)量指標(biāo)在病例組和對(duì)照組間的差異性,以及各指標(biāo)在同一組內(nèi)不同性別以及年齡上的差異性,并計(jì)算各指標(biāo)的受試者工作特征曲線下面積(AUC),確定其診斷界值及相應(yīng)的靈敏度與特異度。結(jié)果:復(fù)發(fā)性髕骨不穩(wěn)患者的髕骨偏移指數(shù)、髕骨傾斜角、滑車(chē)溝角度、ISR及TT-TG距離較健康人群均顯著增大,而股骨外側(cè)滑車(chē)傾斜角顯著減小,且各指標(biāo)相應(yīng)的AUC均0.9。其中:髕骨偏移指數(shù)、髕骨傾斜角和ISR的診斷閾值在女性中較男性分別高出13.8%、3.1°及0.03(P0.05);而TT-TG距離的診斷閾值在16歲成人中較≤16歲青少年兒童高出2.1mm(P0.05)。結(jié)論:伸膝時(shí),MR定量測(cè)量的髕股關(guān)節(jié)指標(biāo)對(duì)復(fù)發(fā)性髕骨不穩(wěn)具有較好的臨床診斷價(jià)值,且部分指標(biāo)具有特異性的性別或年齡的診斷閾值:髕骨偏移指數(shù)、髕骨傾斜角和ISR的診斷界值在女性中明顯高于男性,而TTTG距離的診斷界值在16歲成人中明顯高于≤16歲青少年兒童,即TT-TG距離隨著骨骼發(fā)育的成熟而增加。
[Abstract]:Objective: to investigate the difference of MR quantitative measurement of recurrent patellar instability in different sex and age groups and its diagnostic value. Methods: Fifty-four patients (58 knees) with recurrent patellar instability were selected as the group of patellar instability, and 53 patients (53 healthy knees) with no knee pain were collected. A retrospective MRI image analysis was performed in healthy subjects with trauma and other unwell symptoms as control group. The measurements included: patellar deviation index, patellar inclination angle, trochlear groove angle, lateral femoral trochlear angle, ISR and tibial nodule to femoral trochlear sulcus distance (TT-TG). MannWhitney U test or independent sample t test were used to compare the difference of each measurement index between the case group and the control group, as well as the difference of each index in different sex and age in the same group. The area under the operating characteristic curve (AUC),) was calculated to determine the diagnostic threshold, sensitivity and specificity. Results: the patellar deviation index, patellar inclination angle, trochlear groove angle, ISR and TT-TG distance in patients with recurrent patellar instability were significantly increased, while the lateral femur trochlear angle was significantly decreased. The corresponding AUC of each index was 0.9. The patellar deviation index, patellar obliquity angle and diagnostic threshold of ISR were 13.83.1擄 and 0.03 (P0.05) higher in females than in males (P0.05). The diagnostic threshold of TT-TG distance was higher in 16 years old adults than that in 鈮，

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