骨龄测量在运动损伤致髌股关节不稳患者韧带重建隧道定位的意义
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摘要
目的探讨髌股关节不稳的青少年骨骺闭合程度对内侧髌骨韧带(MPFL)重建术股骨隧道定位的相关性及预后意义。方法分析新疆医科大学第一附属医院2017年1-12月诊断为髌骨脱位的患者35例,手术术式选择内侧髌骨韧带重建术。术前对患者腕关节和膝关节行X线摄片并测量腕关节骨龄和观察膝关节骨骺闭合的程度,比较患者腕关节骨龄和实际年龄的差异,以及在腕关节骨骺闭合的前提下用膝关节骨骺闭合程度定位内侧髌股韧带重建术中股骨隧道的定位点的可行性。结果纳入患者中男性患者的腕关节骨龄和实际年龄相比有提前趋势(P<0.05),女性患者提前趋势不明显(P>0.05)。依据膝关节骨骺闭合程度确定MPFL重建术定位股骨隧道,Lysholm评分和国际膝关节评分委员会(IKDC)评分分别由术前的(61.4±5.1)分和(45.5±4.7)分提高到(91.0±5.3)分和(93.1±4.1)分,差异具有统计学意义(P<0.05),术后Q角、适合角、外侧髌股角、髌骨倾斜角、髌骨移位距离、髌骨外移距离分别为(12.5±3.4)°、(-4.0±3.1)°、(9.1±2.9)°、(3.5±2.1)°、(2.1±1.1)mm、(3.4±1.3)mm,较术前相应数据均有明显提升(P<0.05)。结论仅用腕关节骨龄定位MPFL重建的股骨隧道是不严谨的,膝关节骨骺闭合程度在髌股关节不稳的青少年患者初期治疗中,对于术中内侧髌骨韧带重建的股骨隧道定位有很好的参考价值。
Objective To explore the relationship and significance between juvenileskeletal age estimation and femoral tunnel location in medial patellofemoral ligament reconstruction during patellofemoral joint instability. Methods 35 juvenile patients with habitual patellar dislocation diagnosed in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2017 were enrolled, the surgical approach with medial patellofemoral ligament reconstruction. Preoperative radiographs were performed on the wrist and knee joints to measure the skeletal age and to observe the degree of the closure of the epiphysis of the knee joint, and to explore the difference between the actual age data and the skeletal age data of the wrist. Then the practicability to locate the location of femoral tunnel in the reconstruction of medial patellofemoral ligament by using the degree of knee epiphyseal closure under the condition of wrist joint epiphysis closure completely was observed. Results Compared with the patients′ actual age, the skeletal age of wrist joint in male patients has an early trend, but there was no significant difference in female patients(P>0.05). The Lysholm scores and IKDC scores before operation were(61.4±5.1) and(45.5±4.7), at postoperation were(91.0±5.3) and(93.1±4.1) which was substantial improvement(P<0 05). Q angle, suitable angle, lateral patellar angle, patella tilt angle, patella displacement distance, patella outward displacement distance improved into(12.5±3.4)°,(-4.0±3.1)°,(9.1±2.9)°,(3.5±2.1)°,(2.1±1.1) mm,(3.4±1.3) mm, respectively. Tthe anatomy and the function of the knee were notable improved(P<0.05). Conclusion It is not reasonable to the femoral tunnel localization in medial patellofemoral ligament reconstruction only with the skeletal age of wrist joint. The degree of knee joint epiphyseal closure in the early treatment of juvenile patients with patellofemoral joint instability provides a good reference value for the femoral tunnel localization in medial patellofemoral ligament reconstruction.
Objective To explore the relationship and significance between juvenileskeletal age estimation and femoral tunnel location in medial patellofemoral ligament reconstruction during patellofemoral joint instability. Methods 35 juvenile patients with habitual patellar dislocation diagnosed in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to December 2017 were enrolled, the surgical approach with medial patellofemoral ligament reconstruction. Preoperative radiographs were performed on the wrist and knee joints to measure the skeletal age and to observe the degree of the closure of the epiphysis of the knee joint, and to explore the difference between the actual age data and the skeletal age data of the wrist. Then the practicability to locate the location of femoral tunnel in the reconstruction of medial patellofemoral ligament by using the degree of knee epiphyseal closure under the condition of wrist joint epiphysis closure completely was observed. Results Compared with the patients′ actual age, the skeletal age of wrist joint in male patients has an early trend, but there was no significant difference in female patients(P>0.05). The Lysholm scores and IKDC scores before operation were(61.4±5.1) and(45.5±4.7), at postoperation were(91.0±5.3) and(93.1±4.1) which was substantial improvement(P<0 05). Q angle, suitable angle, lateral patellar angle, patella tilt angle, patella displacement distance, patella outward displacement distance improved into(12.5±3.4)°,(-4.0±3.1)°,(9.1±2.9)°,(3.5±2.1)°,(2.1±1.1) mm,(3.4±1.3) mm, respectively. Tthe anatomy and the function of the knee were notable improved(P<0.05). Conclusion It is not reasonable to the femoral tunnel localization in medial patellofemoral ligament reconstruction only with the skeletal age of wrist joint. The degree of knee joint epiphyseal closure in the early treatment of juvenile patients with patellofemoral joint instability provides a good reference value for the femoral tunnel localization in medial patellofemoral ligament reconstruction.
引文
[1] ELIAS J J,COSGAREA A J.Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage[J].Am J Sports Med,2017,34(9):1478-1485.
[2] 李宁,张志强.复发性髌骨脱位诊治及治疗选择[J].中华临床医师杂志:电子版,2017,11(6):992-996.
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[8] 贺喜顺,魏新军,张绍安,等.儿童髌骨不稳治疗的回顾性分析[J].中华关节外科杂志:电子版,2014,8(1):121-123.
[9] THAUNAT M,ERASMUS P J.Management of overtight medial patellofemoral ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2009,17(5):480-483.
[10] 刘洪亮,许树柴,李敏龙.未成年人前交叉韧带体部完全断裂的修复方法[J].中华关节外科杂志:电子版,2014,8(2):240-243.
[11] 金笑,袁慧书.膝关节不同体位MRI扫描评价前交叉韧带损伤及髌股关节不稳的研究进展[J].磁共振成像,2018,9(09):705-710.
[12] 李祖希,郭敦明,宋黄鹤,等.软组织固定重建内侧髌骨韧带治疗青少年复发性髌骨脱位[J].中国运动医学杂志,2018,37(3):192-196.
[13] 祝钧,祝云利,吴海山,等.不同软组织移植治疗儿童复发性髌骨脱位的比较[J].中国组织工程研究,2013,17(18):3413-3420.
[14] CHRISTOPHER L,CAMP,AARON J,et al.Medial patellofemoral ligament repair for recurrent patellar dislocation[J].Am J Sports Med,2010,38(11):2248-2253.
[2] 李宁,张志强.复发性髌骨脱位诊治及治疗选择[J].中华临床医师杂志:电子版,2017,11(6):992-996.
[3] TRINH T Q,FERREL J R,BENTLEY J C,et al.The anatomy of the medial patelllofemoral ligament[J].Orthopedics,2017,40(4):583-588.
[4] TATEISHI T,TSUCHIYA M,MOTOSUGI N,et al.Graft length change and radiographic assessment of femoral drill hole position for medial patellofemoral ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2011,19(3):400-407.
[5] 宋鑫,李怡璇,陈宏伟.骨龄测定在儿童中的应用效果研究[J].影像研究与医学应用,2018,2(23):226-227.
[6] O′CONNOR J E,COYLE J,SPENCE L D,et al.Epiphyseal maturity indicators at the knee and their relationship to chronological age:results of an Irish population study[J].Clin Anat,2013,26(6):755-767.
[7] 田志强,严天军.儿童骨龄测定的价值与临床应用[J].中国医药指南,2018,16(13):130-131.
[8] 贺喜顺,魏新军,张绍安,等.儿童髌骨不稳治疗的回顾性分析[J].中华关节外科杂志:电子版,2014,8(1):121-123.
[9] THAUNAT M,ERASMUS P J.Management of overtight medial patellofemoral ligament reconstruction[J].Knee Surg Sports Traumatol Arthrosc,2009,17(5):480-483.
[10] 刘洪亮,许树柴,李敏龙.未成年人前交叉韧带体部完全断裂的修复方法[J].中华关节外科杂志:电子版,2014,8(2):240-243.
[11] 金笑,袁慧书.膝关节不同体位MRI扫描评价前交叉韧带损伤及髌股关节不稳的研究进展[J].磁共振成像,2018,9(09):705-710.
[12] 李祖希,郭敦明,宋黄鹤,等.软组织固定重建内侧髌骨韧带治疗青少年复发性髌骨脱位[J].中国运动医学杂志,2018,37(3):192-196.
[13] 祝钧,祝云利,吴海山,等.不同软组织移植治疗儿童复发性髌骨脱位的比较[J].中国组织工程研究,2013,17(18):3413-3420.
[14] CHRISTOPHER L,CAMP,AARON J,et al.Medial patellofemoral ligament repair for recurrent patellar dislocation[J].Am J Sports Med,2010,38(11):2248-2253.