髌股关节形态学与髌骨软化症之间相关性研究
Correlation between patellofemoral morphology and chondromalacia patellae
目的 通过MRI进行髌股关节形态学参数测量，分析髌股关节形态与髌骨软化症之间的关联性。 方法 371例接受膝关节MRI检查的成人患者，诊断为髌骨软化症（chondromalacia patellae，CP）者纳入CP组（n=124），排除CP者纳入对照组（n=247），按性别分组计算CP患病率。通过MRI轴位片测量两组患者的外侧髌股角、滑车沟角、滑车沟深和外侧滑车倾斜角，根据软骨损伤的程度进一步将CP组分为CP（轻型）及CP（重型）两组。运用t检验对比CP组与对照组以及CP（轻型）组与CP（重型）组的各个参数组间差异。进一步运用χ2检验分析髌骨倾斜及滑车发育不良与CP的相关性。 结果 CP的患病率为33.42%（124/371），女性为49.35%（76/154），男性为22.12%（48/217），女性高于男性（P <0.01）；CP组与对照组在外侧髌股角（P =0.00），滑车沟角（P =0.00），滑车沟深（P =0.00）及外侧滑车倾斜角（P =0.02）上均有显著性差异。CP（轻型）组与CP（重型）组在外侧髌股角、滑车沟角、滑车沟深、外侧滑车倾斜角上均未见统计学差异（均P >0.25）。无论是否考虑性别因素，髌骨倾斜与滑车发育不良均与CP存在显著相关性（P =0.00）。 结论 髌骨倾斜及滑车发育不良与CP显著相关，但与CP的严重程度无关。
Objective To measure the morphological parameters of patellofemoral joint on MRI and analyze the etiological correlation between patellofemoral morphology and chondromalacia patellae (CP). Methods 371 adult patients undergoing MRI examination were enrolled and those diagnosed with CP were included in the CP group（n=124）and others in the control group（n=247）. Prevalence rates of CP were recalculated and grouped according to gender. The lateral patellofemoral angle, sulcus angle, trochlear depth and lateral trochlear inclination angle were measured in the MRI images on axial slices. The CP group was further divided into a mild and severe CP subgroup according to the degree of cartilage damage. The difference of patellofemoral morphology parameters among the CP group and control group, CP group (mild) and CP group (severe) were compared and the relationships among patella tilt, trochlear dysplasia and CP were further analyzed. Results The prevalence rate of CP was 33.42%, of which 49.35%was in women and 22.12%was in men. Significant differences in the lateral patellofemoral angle (P=0.00), sulcus angle (P=0.00), trochlear depth (P=0.00) and lateral trochlear inclination angle (P=0.02) could be found in the CP group and control group. However, there were no significant differences between patients in mild CP group and severe CP group in the lateral patellofemoral angle, sulcus angle, trochlear depth and lateral trochlear inclination angle（all P>0.25）. Considered gender or not, patellar tilt and trochlear dysplasia were significant correlated with chondromalacia patellae（P=0.00）. Conclusion Patellar tilt and trochlear dysplasia are significantly correlated with CP but not the degree of CP.
/ 髌骨软化症 / 髌股关节形态 / 髌骨倾斜 / 滑车发育不良
Chondromalacia patellae / Patellofemoral morphology / Patellar tilt / Trochlear dysplasia
[1] Ye QB, Wu ZH, Wang YP, et al. Preliminary investigation on the pathogeny, diagnosis and treatment of chondromalacia patella[J]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2001, 23(2):181-183.
[2] 张文庆, 周湘桂, 易化平, 等. 髌骨软化症病因与治疗研究进展[J]. 中国矫形外科杂志, 2010, 18(22):1884-1886.
[3] Tanamas SK, Teichtahl AJ, Wluka AE, et al. The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study[J]. BMC Musculoskelet Disord, 2010, 11:87.
[4] 曲绵域, 于长隆. 实用运动医学[M]. 4版. 北京:北京大学出版社, 2003: 795.
[5] Ukai T, Sato M, Ishihara M, et al. Usefulness of using laser-induced photoacoustic measurement and 3.0 Tesla MRI to assess knee cartilage damage: a comparison study[J]. Arthritis Res Ther, 2015, 17(1):383.
[6] Laurin CA, Levesque HP, Dussault R, et al. The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation[J]. J Bone Joint Surg Am, 1978, 60(1):55-60.
[7] Tecklenburg K, Dejour D, Hoser C, et al. Bony and cartilaginous anatomy of the patellofemoral joint[J]. Knee Surg Sports Traumatol Arthrosc, 2006, 14(3):235-240.
[8] Pfirrmann CW, Zanetti M, Romero J, et al. Femoral trochlear dysplasia: MR findings[J]. Radiology, 2000, 216(3):858-864.
[9] Carrillon Y, Abidi H, Dejour D, et al. Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience[J]. Radiology, 2000, 216(2):582-585.
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[10] 宿鹏, 张辉. 髌骨倾斜髌骨半脱位与髌骨软化症之间的相关性研究[J]. 中国矫形外科杂志, 2014, 22(15):1365-1368.
[11] 陆薇, 陈爽, 杨军. 髌骨位置与髌骨软化症之间相关性的MRI研究[J]. 中华放射学杂志, 2011, 45(10):955-959.
[12] Ali SA, Helmer R, Terk MR. Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects[J]. AJR Am J Roentgenol, 2010, 194(3):721-727.
[13] Yang B, Tan H, Yang L, et al. Correlating anatomy and congruence of the patellofemoral joint with cartilage lesions[J]. Orthopedics, 2009, 32(1):20.
[14] Endo Y, Schweitzer ME, Bordalo-Rodrigues M, et al. MRI quantitative morphologic analysis of patellofemoral region: lack of correlation with chondromalacia patellae at surgery[J]. AJR Am J Roentgenol, 2007, 189(5):1165-1168.
[15] Tuna BK, Semiz-Oysu A, Pekar B, et al. The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis[J]. Clin Imaging, 2014, 38(4):495-498.
[16] Meh J, Feucht MJ, Bode G, et al. Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3):838-846.
[17] Stefanik JJ, Roemer FW, Zumwalt AC, et al. Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the MOST study[J]. J Orthop Res, 2012, 30(1):1-8.
[18] Meyers AB, Laor T, Sharafinski M, et al. Imaging assessment of patellar instability and its treatment in children and adolescents[J]. Pediatr Radiol, 2016.[Epub ahead of print].
[19] Chen X, Li D, Wang W, et al. Cartilage status in knees with recurrent patellar instability using magnetic resonance imaging T2 relaxation time value[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(8):2292-2296.
国家自然科学基金青年基金（81101389）
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