本文選題：髕骨脫位三聯(lián)術(shù)　切入點(diǎn)：影像測(cè)量值　出處：《上海交通大學(xué)》2015年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:觀察髕骨脫位三聯(lián)術(shù)后隨訪過(guò)程中膝關(guān)節(jié)的CT表現(xiàn)和變化,及其與膝關(guān)節(jié)功能評(píng)分間的關(guān)系。方法:2007年至2015年間共58名(63膝)行髕骨脫位三聯(lián)術(shù)患者納入本研究。術(shù)后所有患者均進(jìn)行至少12個(gè)月以上的CT隨訪評(píng)估并進(jìn)行膝關(guān)節(jié)功能評(píng)分。CT觀察的影像測(cè)量值包括股骨和髕骨骨隧道寬度、股骨側(cè)骨隧道的位置、髕骨外側(cè)傾斜角、髕骨外側(cè)移位值、股骨滑車(chē)溝適合角、外側(cè)髕股角、脛骨結(jié)節(jié)-股骨滑車(chē)溝距離、高位髕骨和股骨滑車(chē)發(fā)育不良分級(jí)。比較術(shù)后3天內(nèi)和術(shù)后最后一次CT中測(cè)量值的變化情況,并將最后一次CT影像表現(xiàn)與膝關(guān)節(jié)功能評(píng)分進(jìn)行相關(guān)性分析。結(jié)果:術(shù)后最后一次隨訪各影像測(cè)量值(平均值±標(biāo)準(zhǔn)差)與術(shù)后3天內(nèi)CT檢查相比,股骨骨隧道寬度、髕骨骨隧道寬度、髕骨傾斜角、髕骨外側(cè)移位值、股骨滑車(chē)溝適合角和外側(cè)髕股角增大,而髕骨高度降低,差異有顯著統(tǒng)計(jì)學(xué)意義。術(shù)后最后一次CT隨訪結(jié)果中,患者的Kujala評(píng)分和Lysholm評(píng)分間無(wú)明顯差異,股骨滑車(chē)發(fā)育不良分級(jí)與Kujala評(píng)分有中等負(fù)相關(guān)性,髕骨外側(cè)移位值和外側(cè)髕股角與Lysholm評(píng)分有中等負(fù)相關(guān)性,股骨側(cè)骨隧道位置在前后位方向上與膝關(guān)節(jié)功能評(píng)分有明顯相關(guān)性,而其余影像測(cè)量值與功能評(píng)分無(wú)明顯相關(guān)性。結(jié)論:髕骨脫位三聯(lián)術(shù)后的隨訪中可以通過(guò)CT觀察到術(shù)后短-中期的膝關(guān)節(jié)改變,包括股骨和髕骨骨隧道擴(kuò)大,以及髕骨傾斜角、髕骨外側(cè)移位值、股骨滑車(chē)溝適合角、外側(cè)髕股角增大和髕骨高位減低。其中髕骨外側(cè)移位值和外側(cè)髕股角增大、高級(jí)別股骨滑車(chē)發(fā)育不良分級(jí)以及股骨骨隧道在前后位方向上的位置異常均會(huì)導(dǎo)致術(shù)后患者膝關(guān)節(jié)功能恢復(fù)較差。因此,CT能及時(shí)發(fā)現(xiàn)有髕骨不穩(wěn)因素或術(shù)后膝關(guān)節(jié)功能恢復(fù)不佳的患者,在髕骨脫位三聯(lián)術(shù)后患者的隨訪中具有重要價(jià)值。
[Abstract]:Objective: to observe the CT features and changes of knee joint during the follow-up of triple patellar dislocation. Methods: from 2007 to 2015, 58 patients (63 knees) underwent triple patellar dislocation. All patients underwent CT follow-up for at least 12 months. Knee function score. The imaging measurements observed by CT included the width of the femoral and patellar tunnel. Location of lateral femoral bone tunnel, lateral angle of patella, lateral displacement of patella, suitable angle of femoral trochlear groove, lateral patellofemoral angle, distance between tibial nodule and femoral trochlear groove, The changes of the measured values in 3 days after operation and the last time after operation were compared between the high patella and femoral trochlear dysplasia. The correlation between CT findings and knee joint function score was analyzed. Results: the width of femoral bone tunnel was compared with that of CT examination within 3 days after the last follow-up (mean 鹵standard deviation). The width of patellar tunnel, the angle of patellar obliquity, the lateral displacement of patella, the suitable angle of femoral trochlear groove and the lateral patellofemoral angle increased, but the height of patella decreased, the difference was statistically significant. There was no significant difference between the Kujala score and the Lysholm score. There was a moderate negative correlation between the femoral trochlear dysplasia grade and the Kujala score, and a moderate negative correlation between the lateral patellar displacement value and the lateral patellofemoral angle and the Lysholm score. The position of femoral lateral bone tunnel was significantly correlated with knee function score in anterior and posterior directions. There was no significant correlation between the other imaging measurements and the functional score. Conclusion: during the follow-up of the triple patellar dislocation, the changes of the knee joint were observed by CT, including the enlargement of the femoral and patellar tunnel and the patellar obliquity angle. The lateral displacement value of patella, the angle of femur trochlear groove, the increase of lateral patellofemoral angle and the decrease of patellar high position, in which the lateral displacement value of patella and the lateral patellofemoral angle increased, The grade of high grade femoral trochlear dysplasia and the abnormal position of femoral bone tunnel in anteroposterior direction will result in poor recovery of knee joint function. Therefore, CT can detect patellar instability or postoperative knee closure in time. Patients with poor recovery, It has important value in the follow-up of patients with patellar dislocation after triple operation.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3;R816.8

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本文編號(hào)：1612205