【摘要】 目的 :通过分析髌股关节退变性骨关节病(patello-femoral degenerative arthrosis,PFDA)患者的胫骨扭转畸形与髌股关节在静力及动力条件下排列紊乱的关系,揭示胫骨扭转畸形诱发PFDA的可能机制。方法:自2009年10月至2010年10月,选取PFDA患者50例86膝,男24膝,女62膝;对照组16例23膝,男7膝,女16膝。分别在CT扫描片上测量胫骨扭转角,并测量屈膝30°位时,分别在静力和动力条件下的髌股和谐角及外侧髌股角,经统计学对比分析后,评价PFDA患者的胫骨扭转畸形与髌股关节排列紊乱的关系。进而将PFDA患者按胫骨扭转角大小分为胫骨扭转角过大组(胫骨扭转角≥30°)、胫骨扭转角过小组(胫骨扭转角<15°)和胫骨扭转角正常组(15°≤胫骨扭转角<30°),测量屈膝30°位时,分别在静力和动力条件下髌股和谐角和外侧髌股角,进行统计学处理,分析PFDA患者胫骨扭转畸形与髌股关节排列紊乱的关系,尤其在动力条件下的关系。结果:PFDA患者的胫骨扭转角(30.30±7.11)°,大于对照组(23.10±4.73)°;与对照组比较,PFDA患者有较大的髌股和谐角(13.20±3.94)°及较小的外侧髌股角(12.30±3.04)°。胫骨扭转角过小组和胫骨扭转角过大组在静力及动力条件下的髌股和谐角和外侧髌股角比较,差异有统计学意义(P<0.05)。而胫骨扭转角正常组的髌股和谐角在静力和动力条件下比较,差异无统计学意义;外侧髌股角在静力和动力条件下比较,差异亦无统计学意义。结论:胫骨扭转畸形者多伴有髌股关节不稳,尤其是动力状态下的匹配关系紊乱,是造成PFDA患者髌股关节紊乱的主要原因。CT检测髌股关节及胫骨扭转角,既能提供髌股关节排列的信息和髌股关节的退变状况,又能通过对两者对应关系的分析为临床更好地预防和早期治疗退变性骨关节病提供指导。更多还原

【Abstract】 Objective:To reveal the possible mechanism involved in patella femoral degenerative arthritis(PFDA) induced by torsion deformity of tibia via analyzing the relationship between torsion deformity of the tibia in patients with PFDA and the disorder of patella femoral joint under the static and dynamic conditions. Methods:From October 2009 to October2010,50 patients(86 knees,24 knees of male patients and 62 knees of female patients) with PFDA were classified as disease group and 16 people(23 knees,7 knees of males and 16 knees of females) in the control group. The follow indexes were measured:the torsion angle of tibia on CT scanning imagings,the patella femoral congruence angle and lateral patella femoral angle under static and dynamic conditions when the knee bent at 30 degrees of flexion. Based on the measurement results,the relationship between the torsion deformity of tibias and the disorders of patella femoral joints in patients with PFDA were analyzed. Finally,the patients were divided into three groups including large torsion angle group,small torsion angle group and normal group according to the size of torsion angle,in order to analyze the relationship between torsion deformity and disorders of patella femoral joint,especially under the dynamic conditions. Results:Compared with patients without PFDA,the ones with PFDA had bigger torsion angle(30.30±7.11)° of tibia,larger patella femoral congruence angle(13.20±3.94)° and smaller lateral patella femoral angle(12.30 ±3.04)°. The congruence angle and lateral patella femoral angle under static and dynamic conditions had statistical differences respectively in both too big torsion angle group and too small torsion angle group. The congruence angle and lateral patella femoral angle under static and dynamic conditions had no statistical differences in normal torsion angle group. Conclusion:Torsion deformity of tibia is the main reason for disorder of patella femoral joint in the patients with PFDA. Torsion deformity of tibia is always accompanied by instability of patella femoral joint,especially under the dynamic condition,thus causing PFDA. It can not only provide arrangement information and degenerative condition of patella femoral joint,but also provide guidance through the analysis on the relationship for better clinical prevention and early treatment of degenerative bone and joint disease.更多还原