髌骨脱位术后CT表现及与膝关节功能关系研究

发布时间：2018-03-14 17:26

本文选题：髌骨脱位三联术　切入点：影像测量值　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:观察髌骨脱位三联术后随访过程中膝关节的CT表现和变化,及其与膝关节功能评分间的关系。方法:2007年至2015年间共58名(63膝)行髌骨脱位三联术患者纳入本研究。术后所有患者均进行至少12个月以上的CT随访评估并进行膝关节功能评分。CT观察的影像测量值包括股骨和髌骨骨隧道宽度、股骨侧骨隧道的位置、髌骨外侧倾斜角、髌骨外侧移位值、股骨滑车沟适合角、外侧髌股角、胫骨结节-股骨滑车沟距离、高位髌骨和股骨滑车发育不良分级。比较术后3天内和术后最后一次CT中测量值的变化情况,并将最后一次CT影像表现与膝关节功能评分进行相关性分析。结果:术后最后一次随访各影像测量值(平均值±标准差)与术后3天内CT检查相比,股骨骨隧道宽度、髌骨骨隧道宽度、髌骨倾斜角、髌骨外侧移位值、股骨滑车沟适合角和外侧髌股角增大,而髌骨高度降低,差异有显著统计学意义。术后最后一次CT随访结果中,患者的Kujala评分和Lysholm评分间无明显差异,股骨滑车发育不良分级与Kujala评分有中等负相关性,髌骨外侧移位值和外侧髌股角与Lysholm评分有中等负相关性,股骨侧骨隧道位置在前后位方向上与膝关节功能评分有明显相关性,而其余影像测量值与功能评分无明显相关性。结论:髌骨脱位三联术后的随访中可以通过CT观察到术后短-中期的膝关节改变,包括股骨和髌骨骨隧道扩大,以及髌骨倾斜角、髌骨外侧移位值、股骨滑车沟适合角、外侧髌股角增大和髌骨高位减低。其中髌骨外侧移位值和外侧髌股角增大、高级别股骨滑车发育不良分级以及股骨骨隧道在前后位方向上的位置异常均会导致术后患者膝关节功能恢复较差。因此,CT能及时发现有髌骨不稳因素或术后膝关节功能恢复不佳的患者,在髌骨脱位三联术后患者的随访中具有重要价值。
[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 卤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.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3;R816.8

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