股骨旋转和髌股关节运动学：负重磁共振成像分析。

Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis.

机构信息

Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA.

出版信息

J Orthop Sports Phys Ther. 2010 May;40(5):277-85. doi: 10.2519/jospt.2010.3215.

DOI:10.2519/jospt.2010.3215

PMID:20436239

Abstract

STUDY DESIGN

Controlled laboratory study using a cross-sectional design.

OBJECTIVES

To compare patellofemoral joint kinematics, femoral rotation, and patella rotation between females with patellofemoral pain (PFP) and pain-free controls using weight-bearing kinematic magnetic resonance imaging.

BACKGROUND

Recently, it has been recognized that patellofemoral malalignment may be the result of femoral motion as opposed to patella motion.

METHODS

Fifteen females with PFP and 15 pain-free females between the ages of 18 and 45 years participated in this study. Kinematic imaging of the patellofemoral joint was performed using a vertically open magnetic resonance imaging system. Axial-oblique images were obtained using a fast gradient-echo pulse sequence. Images were acquired at a rate of 1 image per second while subjects performed a single-limb squat. Measures of femur and patella rotation (relative to the image field of view), lateral patella tilt, and lateral patella displacement were made from images obtained at 45 degrees , 30 degrees , 15 degrees , and 0 degrees of knee flexion. Group differences were assessed using a mixed-model analysis of variance with repeated measures.

RESULTS

When compared to the control group, females with PFP demonstrated significantly greater lateral patella displacement at all angles evaluated and significantly greater lateral patella tilt at 30 degrees , 15 degrees , and 0 degrees of knee flexion. Similarly, greater medial femoral rotation was observed in the PFP group at 45 degrees , 15 degrees , and 0 degrees of knee flexion when compared to the control group. No group differences in patella rotation were found.

CONCLUSION

Altered patellofemoral joint kinematics in females with PFP appears to be related to excessive medial femoral rotation, as opposed to lateral patella rotation. Our results suggest that the control of femur rotation may be important in restoring normal patellofemoral joint kinematics. J Orthop Sports Phys Ther 2010;40(5):277-285, Epub 12 March 2010. doi:10.2519/jospt.2010.3215.

摘要

研究设计

采用横断面设计的对照实验室研究。

目的

通过负重运动磁共振成像比较髌股关节运动学、股骨旋转和髌骨旋转，以比较髌股疼痛（PFP）女性与无痛对照组女性。

背景

最近，人们认识到髌股对线不良可能是股骨运动的结果，而不是髌骨运动的结果。

方法

本研究纳入了 15 名 PFP 女性和 15 名 18 至 45 岁之间无痛的女性。使用垂直开放式磁共振成像系统进行髌股关节运动学成像。使用快速梯度回波脉冲序列获得轴向斜位图像。在受试者进行单腿深蹲时，以每秒 1 幅图像的速度采集图像。在膝关节 45°、30°、15°和 0°时，从获得的图像中测量股骨和髌骨旋转（相对于图像视野）、髌骨外侧倾斜和髌骨外侧移位。使用重复测量混合模型方差分析评估组间差异。

结果

与对照组相比，PFP 女性在所有评估角度的髌骨外侧移位明显更大，在膝关节 30°、15°和 0°时的髌骨外侧倾斜明显更大。同样，与对照组相比，PFP 组在膝关节 45°、15°和 0°时，股骨内侧旋转明显更大。未发现髌骨旋转存在组间差异。

结论

PFP 女性髌股关节运动学的改变似乎与过度的股骨内侧旋转有关，而不是髌骨外侧旋转。我们的结果表明，控制股骨旋转可能对恢复正常髌股关节运动学很重要。J Orthop Sports Phys Ther 2010;40(5):277-285，2010 年 3 月 12 日在线发表。doi:10.2519/jospt.2010.3215.