MRI关于急性髌骨脱位的多因素相关性研究

发布时间：2018-02-03 22:21

  本文关键词： 急性髌骨脱位 磁共振扫描 解剖学危险因素　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:从影像学角度分析各急性髌骨脱位解剖学危险因素之间的关系,通过影像学表现试图探讨急性髌骨脱位发生的机制,并为临床治疗提供参考依据。方法:回顾性分析75例78膝2014年12月-2016年12月在广州中医药大学第三附属医院门诊部或住院部行MRI检查,影像诊断符合急性髌骨脱位的患者,并分为青少年组和成人组。将图像进行后处理,测量各解剖学危险因素指标,统计急性髌骨脱位患者的髌骨状态、髌骨内侧支持带损伤的部位及程度、骨软骨损伤的部位及损伤级别。采用SPSS22.0统计分析软件进行一系列分析,运用非参数检验比较青少年组和成人组连续变量型解剖学危险因素的差异,χ2检验比较两组的解剖学危险因素出现的阳性数(率)之间的差异,使用因子分析找出合理描述四个解剖学危险因素与急性髌骨脱位的关系,运用偏相关分析分析解剖学危险因素各测量指标之间的相关性。认为P0.05具有统计学意义。结果:(1)髌骨高位方面,两组患者ISI平均值和阳性率之间的差异均具有统计学意义(P值分别为0.014、0.04),即青少年组和成人组在髌骨高位方面存在差异。(2)用股骨滑车深度、骨性股骨滑车凹角、软骨性股滑车凹角3个连续性变量指标来描述股骨滑车发育不良,经因子分析,股骨滑车深度为导致股骨滑车发育不良的第一主成分,即股骨滑车深度对股骨滑车发育不良的解释度最好。(3)骨性TT-TG距离和腱性-软骨性TT-TG距离中,将其测量值15mm做为阳性参考值时,青少年组和成人组之间发生骨性TT-TG距离增加的百分比之间存在统计学差异(P=0.015)。发生腱性-软骨性TT-TG距离增加的百分比之间两组患者之间无明显统计学差异(P0.05)。(4)两组患者在髌骨倾斜方面的数据在平均值和阳性率上无明显统计学差异(P0.05)。经因子分析,髌骨倾斜为导致急性髌骨脱位的解剖学危险因素第一主成分。(5)经因子分析,定义ISI1.3者为髌骨高位,股骨滑车深度3mm者为股骨滑车发育不良,骨性TT-TG距离15mm为胫骨结节外移,外侧滑车倾斜角≤0°为髌骨倾斜,运用偏相关分析,控制年龄因素后,结果显示:外侧滑车倾斜角与股骨滑车深度呈正相关(r=0.245,P=0.035)、与骨性TT-TG距离及髌骨高位无明显相关性(P0.05);股骨滑车深度与骨性TT-TG距离呈负相关(r=-0.323,P=0.005),与髌骨高位之间无明显相关性(P0.05);髌骨高位与骨性TT-TG距离之间无明显相关性(P0.05)。(6)影像学表现方面,经χ2检验,两者在髌骨内侧支持带损伤的部位和程度之间无明显差异(P0.05),两者在骨软骨损伤的损伤的位置上存在统计学差异(P=0.011)。结论:导致青少年和成人急性髌骨脱位的解剖学危险因素在髌骨高位和骨性TT-TG距离增加方面存在差异。髌骨倾斜为导致急性髌骨脱位的主要危险因素,但其伴随股骨滑车发育不良发生,二者之间具有正相关性,股骨滑车发育不良与胫骨结节外移之间存在负相关性。影像学表现上,青少年组和成年组急性髌骨脱位患者在骨软骨损伤的部位上存在差异。
[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.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R681.8
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本文编号：1488507