本文關(guān)鍵詞： 急性髕骨脫位 磁共振掃描 解剖學(xué)危險因素　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:從影像學(xué)角度分析各急性髕骨脫位解剖學(xué)危險因素之間的關(guān)系,通過影像學(xué)表現(xiàn)試圖探討急性髕骨脫位發(fā)生的機(jī)制,并為臨床治療提供參考依據(jù)。方法:回顧性分析75例78膝2014年12月-2016年12月在廣州中醫(yī)藥大學(xué)第三附屬醫(yī)院門診部或住院部行MRI檢查,影像診斷符合急性髕骨脫位的患者,并分為青少年組和成人組。將圖像進(jìn)行后處理,測量各解剖學(xué)危險因素指標(biāo),統(tǒng)計急性髕骨脫位患者的髕骨狀態(tài)、髕骨內(nèi)側(cè)支持帶損傷的部位及程度、骨軟骨損傷的部位及損傷級別。采用SPSS22.0統(tǒng)計分析軟件進(jìn)行一系列分析,運(yùn)用非參數(shù)檢驗比較青少年組和成人組連續(xù)變量型解剖學(xué)危險因素的差異,χ2檢驗比較兩組的解剖學(xué)危險因素出現(xiàn)的陽性數(shù)(率)之間的差異,使用因子分析找出合理描述四個解剖學(xué)危險因素與急性髕骨脫位的關(guān)系,運(yùn)用偏相關(guān)分析分析解剖學(xué)危險因素各測量指標(biāo)之間的相關(guān)性。認(rèn)為P0.05具有統(tǒng)計學(xué)意義。結(jié)果:(1)髕骨高位方面,兩組患者ISI平均值和陽性率之間的差異均具有統(tǒng)計學(xué)意義(P值分別為0.014、0.04),即青少年組和成人組在髕骨高位方面存在差異。(2)用股骨滑車深度、骨性股骨滑車凹角、軟骨性股滑車凹角3個連續(xù)性變量指標(biāo)來描述股骨滑車發(fā)育不良,經(jīng)因子分析,股骨滑車深度為導(dǎo)致股骨滑車發(fā)育不良的第一主成分,即股骨滑車深度對股骨滑車發(fā)育不良的解釋度最好。(3)骨性TT-TG距離和腱性-軟骨性TT-TG距離中,將其測量值15mm做為陽性參考值時,青少年組和成人組之間發(fā)生骨性TT-TG距離增加的百分比之間存在統(tǒng)計學(xué)差異(P=0.015)。發(fā)生腱性-軟骨性TT-TG距離增加的百分比之間兩組患者之間無明顯統(tǒng)計學(xué)差異(P0.05)。(4)兩組患者在髕骨傾斜方面的數(shù)據(jù)在平均值和陽性率上無明顯統(tǒng)計學(xué)差異(P0.05)。經(jīng)因子分析,髕骨傾斜為導(dǎo)致急性髕骨脫位的解剖學(xué)危險因素第一主成分。(5)經(jīng)因子分析,定義ISI1.3者為髕骨高位,股骨滑車深度3mm者為股骨滑車發(fā)育不良,骨性TT-TG距離15mm為脛骨結(jié)節(jié)外移,外側(cè)滑車傾斜角≤0°為髕骨傾斜,運(yùn)用偏相關(guān)分析,控制年齡因素后,結(jié)果顯示:外側(cè)滑車傾斜角與股骨滑車深度呈正相關(guān)(r=0.245,P=0.035)、與骨性TT-TG距離及髕骨高位無明顯相關(guān)性(P0.05);股骨滑車深度與骨性TT-TG距離呈負(fù)相關(guān)(r=-0.323,P=0.005),與髕骨高位之間無明顯相關(guān)性(P0.05);髕骨高位與骨性TT-TG距離之間無明顯相關(guān)性(P0.05)。(6)影像學(xué)表現(xiàn)方面,經(jīng)χ2檢驗,兩者在髕骨內(nèi)側(cè)支持帶損傷的部位和程度之間無明顯差異(P0.05),兩者在骨軟骨損傷的損傷的位置上存在統(tǒng)計學(xué)差異(P=0.011)。結(jié)論:導(dǎo)致青少年和成人急性髕骨脫位的解剖學(xué)危險因素在髕骨高位和骨性TT-TG距離增加方面存在差異。髕骨傾斜為導(dǎo)致急性髕骨脫位的主要危險因素,但其伴隨股骨滑車發(fā)育不良發(fā)生,二者之間具有正相關(guān)性,股骨滑車發(fā)育不良與脛骨結(jié)節(jié)外移之間存在負(fù)相關(guān)性。影像學(xué)表現(xiàn)上,青少年組和成年組急性髕骨脫位患者在骨軟骨損傷的部位上存在差異。
[Abstract]:Objective: to analyze the relationship between the risk factors of acute dislocation of patella anatomy from the perspective of imaging, the imaging findings of attempts to explore the mechanism of acute patellar dislocation occurred, and provide reference for clinical treatment. Methods: a retrospective analysis of 75 cases of 78 knees in December 2014 -2016 year in December in the outpatient department of the Third Affiliated Hospital of Guangzhou University of Chinese Medicine or inpatient department for MRI check, diagnosis with acute patellar dislocation in patients were divided into young group and adult group. The image postprocessing, measure factors of each anatomic risk of acute dislocation of patella, statistics of patella, patellar medial support position and degree of damage location and damage level, osteochondral injury. By SPSS22.0 statistics the analysis software to carry out a series of analysis, using non parametric test in adolescent group and adult group continuous variable anatomical risk factors for poor ISO, positive number 2 test was compared between the two groups of anatomic risk factors (rate) the difference between the use of factor analysis to find out the reasonable description of the relationship of four anatomical risk factors and acute patellar dislocation, using partial correlation analysis the correlation between the measurements of anatomic risk factors. Considered statistically significant. Results: P0.05 (1) the patella high, the difference between the two groups of patients with the average value of ISI and the positive rate were statistically significant (P = 0.014,0.04), the youth group and adult group in the aspects of high riding patella are different. (2) with femoral trochlear depth, bony cartilage of the femoral trochlear concave, concave block 3 a continuous variable index to describe the femoral trochlear dysplasia, through factor analysis, trochlear depth as the first principal component lead to femoral trochlear dysplasia, the femoral trochlea depth development of femoral trochlea The best explanation for the poor. (3) the TT-TG distance of tendon and bony - cartilaginous TT-TG distance, the measured value of 15mm as a positive reference value, there was significant difference between the percentage of bony TT-TG increased distance between the youth group and adult group (P=0.015). Between the percentage of tendon cartilage TT-TG the increased distance between the two groups had no significant difference (P0.05). (4) two groups of patients with tilt data on no statistically significant in the average value and positive rate difference in the patella (P0.05). Through factor analysis, the first principal component to lead to patellar tilt acute dislocation of patella anatomic risk factors (5. Through factor analysis, the definition of ISI1.3) for patella high, trochlear depth 3mm for femoral trochlear dysplasia, bone TT-TG 15mm is the distance of tibial tubercle shift, lateral trochlear inclination angle is smaller than 0 DEG patella tilt, using partial correlation analysis, After controlling for age, the results showed that the lateral trochlear inclination angle was positively correlated with trochlear depth (r=0.245, P=0.035), no significant correlation with TT-TG distance and high bony patella (P0.05); negative correlation trochlear depth and bony TT-TG distance (r=-0.323, P= 0.005), and no significant correlation between patella high (P0.05); there was no correlation between the patella and high bony TT-TG distance (P0.05). (6) imaging, by 2 test, both in the medial patella support there is no significant difference between the position and degree of damage (P0.05), there were significant differences in both bone and cartilage damage position (P=0.011). Conclusion: the anatomic risk lead to adolescents and adults with acute patellar dislocation of patella and bony factors in the high TT-TG range increased the difference. The patellar tilt is mainly caused the risk of acute patellar dislocation, but with the With the occurrence of femoral trochlear dysplasia, there is a positive correlation between the two. There is a negative correlation between the femoral trochlear dysplasia and the tibial tubercle extroversion.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R445.2;R681.8
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本文編號：1488507