| 丁明,上官磊,张楠,等.胫骨结节相对旋转度：一种新的评估髌股关节不稳的参数.骨科,2022,13(4): 320-324. |
| 胫骨结节相对旋转度：一种新的评估髌股关节不稳的参数 |
| Tibial Tubercle-Trochlear Groove Rotation Angle: A New Parameter for Evaluating Patellofemoral Instability |
| 投稿时间：2022-03-07 |
| DOI：10.3969/j.issn.1674-8573.2022.04.007 |
| 中文关键词: 髌股不稳 髌骨脱位 胫骨结节 胫骨结节相对旋转度 胫骨结节-滑车距离 |
| 英文关键词: Patellofemoral instability Patellar dislocation Tibial tubercle Tibial tubercle trochlear groove rotation angle Tibial tubercle trochlear distance |
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| 中文摘要: |
| 目的 探讨胫骨结节相对旋转度（tibial tubercle-trochlear groove rotation angle，TTTGR）与髌股关节不稳的相关性，评估这一参数对于髌股关节不稳的诊断效力。方法 收集2020年1月至2020年12月于我科就诊的髌骨复发性脱位病人50例纳入脱位组，30例正常志愿者纳入对照组。四名观察者分别对两组病人的双膝关节CT影像进行分析，测量TTTGR、胫骨结节-滑车（tibial tubercle-trochlear groove，TT-TG）距离、滑车侧倾角（lateral trochlear inclination，LTI）、髌骨外倾角度（lateral patella tilt angle，LPTA）。评估各参数在观察者间的一致性，分析两组间上述参数的差异，TTTGR与其他参数的相关性，采用受试者工作特征（receiver operating characteristic，ROC）曲线分析各参数对于预测髌股关节不稳的灵敏度、特异度、阳性及阴性预测值。结果 脱位组的TTTGR、TT-TG、LPTA均显著高于对照组，LTI显著低于对照组，组间比较，差异有统计学意义（P＜0.05）。观察者间的一致性检验结果：TT-TG（ICC=0.975）、TTTGR（ICC=0.937）和LPTA（ICC=0.794）的组间一致性均为优秀，LTI（ICC=0.708）的组间一致性良好。TTTGR与TT-TG、LPTA呈正相关（r=0.544，r=0.476），与LTI呈负相关（r=-0.430）。TT-TG对于髌股关节不稳的诊断准确性最高，约登指数：0.851，TTTGR诊断准确性次之（约登指数：0.733），LTI则无诊断意义。其中，TTTGR的最佳截断值为34.6°，表现出敏感度为80.00%，特异度为93.30%；阳性预测值为92.27%，阴性预测值为82.34%。结论 TTTGR是可重复性高、可靠的髌股关节不稳评估指标，与TT-TG、LPTA等参数具有相关性，对于髌股关节不稳具有较高的诊断效力。 |
| 英文摘要: |
| Objective To investigate the correlation between tibial tubercle-trochlear groove rotation angle (TTTGR) and patellofemoral instability, and to evaluate the diagnostic efficacy of this parameter for patellofemoral instability. Methods From January 2020 to December 2020, 50 patients with recurrent dislocation of patella treated in our department were included in the dislocation group, and 30 normal volunteers were included in the control group. Four observers measured TTTGR, tibial tubercle-trochlear groove (TT-TG) distance, lateral trochlear inclination (LTI) and lateral patella tilt angle (LPTA) on CT images of two groups. The intra-class correlation coefficient between observers, the differences between two groups, and the correlation between TTTGR and other parameters were observed. The sensitivity, specificity, positive and negative predictive values of TTTGR were analyzed by the ROC curve. Results TTTGR, TT-TG and LPTA in dislocation group were significantly higher than those in control group, and LTI was significantly lower than that in control group, with significant difference between two groups (P＜0.05). The intra-class correlation coefficient among observers of TTTGR (ICC=0.937), TT-TG (ICC=0.975) and LPTA (ICC=0.794) was excellent, and LTI (ICC=0.708) was good. TTTGR was positively correlated with TT-TG and LPTA (r=0.544, r=0.476), and negatively correlated with LTI (r=-0.430). TT-TG had the highest accuracy in the diagnosis of patellofemoral instability (Yoden index: 0.851), TTTGR was second (Yoden index: 0.733), while LTI had no diagnostic significance. TTTGR=34.6° showed a sensitivity of 80.00% and a specificity of 93.30%; The positive predictive value was 92.27%, and the negative predictive value was 82.34%. Conclusion TTTGR was a highly reproducible and reliable evaluation parameter of patellofemoral instability, which was correlated with other evaluation parameters of patellofemoral instability, and had high diagnostic efficacy for patellofemoral instability. |
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