急性髌骨脱位与复发性髌骨脱位易感的分析与临床调查

发布时间：2018-05-21 05:06

本文选题：髌骨脱位 + 髌骨不稳　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景:随着我国经济的发展,人口逐步增长,髌骨脱位及髌骨周围组织损伤所造成的髌骨不稳定的患者也逐渐增多。膝关节外伤常可导致髌股内侧支持带损伤,引起膝关节前部疼痛,严重时可引起患肢膝关节稳定性下降,甚至造成患者患肢活动障碍。若该损伤未能得到及有效时的治疗,则膝关节髌股关节面不稳将导致关节面软骨磨损加速,远期发生膝关节骨性关节炎的风险较高。而就髌骨脱位而言,该病的易感因素作用与疾病的发生及发展有着较为密切的联系。随着医学科学的发展和进步,近年来越来越多的易感因素被纳入到髌骨脱位易感性的评价体系中来,并且已经取得了一定的研究结果,特别是在影像学相关的对于易感因素的诊断方面。但是对于髌骨脱位易感因素综合作用及诸多易感因素的关系的相关研究较少,且并无一科学有效并得到广泛认可的评价体系来评价髌骨脱位的患病风险。目的:探讨影响髌骨脱位发生的众多易感因素的作用强弱、易感因素之间的相互作用规律以及由急性初次髌骨脱位转变为复发性髌骨脱位的主要易感因素及其作用强弱。方法:回顾性分析我院2010年1月至2016年10月就诊于我院并以“髌骨脱位”为主要诊断收入我科的患者122例,将其分为急性初次脱位组(初发组):共42例,和复发型脱位组(复发组):共80例。收集患者的患肢膝关节正侧位平片、膝关节mr平扫以及ct平扫影像学资料。其中患者年龄16.3±5.4,性别:男:70例,女:52例。分别对初发组和复发组的患者进行测量。收集其年龄、性别、髌骨形态分型、髌骨高度、髌骨倾斜、滑车形态分型、滑车沟深度、滑车外侧倾斜角、tt-tg距离以及q角等资料,并对所收集的资料进行统计学分析。分析所收集的易感因素中各因素所占比例,并比较初发组与复发组中各个易感因素之间是否具有统计学差异。除此之外,选取初发组与复发组中具有显著差异的易感因素用于评分系统的制作,用于评价髌骨脱位由初次脱位转变为复发脱位的风险。结果:初发组年龄为17±3.3岁,复发组年龄为15±5.2岁,具有显著差异(p0.05)。初发组insall-salvati值为1.30±0.16,复发组为1.37±0.13,具有显著差异(p0.05)。初发组髌骨倾斜角:17°±4.8,复发组髌骨倾斜角为:20°±6.8,具有显著差异(p0.05)。初发组滑车沟深度:2.2±0.15mm,复发组滑车沟深度:2.1±0.23mm,具有统计学差异(p0.05)。初发组滑车外侧倾斜角:12.2°±0.05,复发组滑车外侧倾斜角:12.5°±0.08,两者经统计学分析无明显差异。初发组tt-tg距离12±7.4mm,复发组tt-tg距离16±8.8mm,两组间具有显著差异(p0.05)。初发组:q角:22°±2.2,复发组:q角:23°±1.5,不具有显著差异。初发组:男性28人,女性14人,复发组:男性42人,女性38人。不具显著差异。初发组:轻度滑车发育不良18人,重度滑车发育不良:24人,复发组:轻度滑车发育不良12人,重度滑车发育不良68人。具有显著差异。初发组:WibergⅠ型18人,WibergⅡ型10人,WibergⅢ型14人,复发组WibergⅠ型30人,WibergⅡ型28人,WibergⅢ型22人,不具有显著差异。总体样本中各易感因素比例:高位髌骨占90.16%(110),髌骨倾斜占70.49%(86),滑车发育不良95.83%(115),胫骨结节外移75.41%(92),股骨前倾过大68.85%(84),年龄小于16岁:59.01%(72),男性57.38%(70),女性42.62%(52),WibergⅠ型:39.34%(48),WibergⅡ型31.15%(38),WibergⅢ型29.51%(36)。选取年龄、髌骨高度、髌骨倾斜、滑车发育情况以及胫骨结节位置这5项易感因素制作评分系统。以复发组80名患者的得分分析易感因素,其中0分2人,1分5人,2分11人,3分人36,4分21人,5分7人。结论:1.在众多髌骨脱位易感因素中滑车发育不良对于髌骨脱位的发生的作用最为重要。2.年龄、髌骨高度、髌骨倾斜、滑车发育情况以及胫骨结节位置这5项易感因素在初次髌骨脱位转变为复发型髌骨脱位的过程中有重要作用。3.复发脱位风险评分系统能有效评价患者复发脱位的风险。
[Abstract]:Background: with the development of China's economy and the gradual increase of population, patellar instability caused by dislocation of patella and the injury of the surrounding patellar tissue is increasing. The knee joint trauma often leads to the injury of the medial patellar retinaculum, causing pain in the front of the knee joint, which can cause the stability of the knee joint to decrease and even cause the suffering of the knee joint. If the injury is not available and effective, the instability of the patellar joint surface of the knee joint will lead to the acceleration of the articular cartilage wear, and the risk of the long-term knee osteoarthritis is higher. As for the patellar dislocation, the susceptibility factor of the disease is closely related to the occurrence and development of the disease. With the development and progress of medical science, more and more susceptible factors have been brought into the evaluation system of patellar dislocation susceptibility in recent years, and some research results have been obtained, especially in the diagnosis of susceptibility factors related to imaging. There is less research on the relationship of factors, and there is no scientific and effective evaluation system to evaluate the risk of patellar dislocation. Objective: To explore the effect of many susceptible factors that affect patellar dislocation, the interaction between the susceptible factors and the change from the acute first patellar dislocation to recurrence. Methods: a retrospective analysis of 122 patients in our hospital from January 2010 to October 2016 with "patellar dislocation" as the main diagnostic income of our department was divided into 42 cases of acute initial dislocation group (primary group): a total of 80 cases (relapse group): a total of 80 cases. Mr plain scan of the knee joint of the affected limb, flat scan of knee joint and CT plain scan imaging data. The age of the patients was 16.3 + 5.4, sex: male: 70 cases and 52 cases. The age, sex, patellar morphology, patellar height, patellar tilting, trochlear shape, trochlear depth, and trochlear were collected. The data collected by the oblique angle, the TT-TG distance and the Q angle were statistically analyzed. The proportion of the factors in the susceptible factors collected was analyzed, and the statistical difference between the primary and recurrent groups was compared. Sensory factors were used to make a scoring system for evaluating the risk of patellar dislocation from initial dislocation to recurrent dislocation. Results: the age of the first group was 17 + 3.3 years, the age of the recurrent group was 15 + 5.2 years, with a significant difference (P0.05). The initial group insall-salvati was 1.30 + 0.16, the relapse group was 1.37 + 0.13, with a significant difference (P0.05). Patellar patella in the primary group. The angle of bone inclination was 17 + 4.8. The patellar tilting angle of the recurrent group was 20 + 6.8 (P0.05). The depth of the trochlear groove in the primary group was 2.2 + 0.15mm, and the depth of the trochlear trench in the recurrent group was 2.1 + 0.23mm, with statistical difference (P0.05). The lateral inclination of the trochlear in the primary group was 12.2? 0.05, and the lateral inclination of the trochlear in the recurrent group was 12.5? 0.08. The statistical credits were counted. The TT-TG distance of the primary group was 12 + 7.4mm, and the TT-TG distance in the recurrent group was 16 + 8.8mm, and the two groups had significant differences (P0.05). The initial group was Q angle: 22 + 2.2. The recurrent group was Q angle: 23 / 1.5, no significant difference. The primary group was 42 men, 14 women and 38. No significant difference. The primary group: mild trochlear hair There were 18 poor children and 24 severe trochlear dysplasia: 12 patients with mild trochlear dysplasia and 68 severe trochlear dysplasia. There were 18 Wiberg type I, 10 Wiberg type II, 14 Wiberg type III, Wiberg type I in relapse group, Wiberg type I 28, and 22 Wiberg III, with no significant difference. The proportion of various susceptibility factors: 90.16% (110) of high patellar bone, 70.49% (86) of patellar tilting, 95.83% (115) of trochlear dysplasia, 75.41% (92) of tibial tubercle, 68.85% (84) of femur, younger than 16 years of age: 59.01% (72), Wiberg type I, Wiberg type I, Wiberg type III type. Taking age, patellar height, patellar tilt, trochlear development and tibial nodule position, the scoring system was made to make a scoring system. The scores of 80 patients in the recurrent group were analyzed easily, including 0 points, 2, 1, 5, 2, 11, 3 36,4 21, 5 7. Conclusion: 1. in numerous patellar dislocation factors, 1. slide car dysplasia in many patellar dislocation factors. The most important.2. age, the height of the patella, the patellar tilt, the development of the trochlear and the position of the tibial tubercle, the 5 susceptible factors of patellar dislocation have an important role in the transformation of the initial patellar dislocation into a recurrent patellar dislocation. The risk of recurrent dislocation of.3. can be effectively evaluated by the risk score of recurrent dislocation of the patellar dislocation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.8

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