Tensho Keiji, Akaoka Yusuke, Shimodaira Hiroki, Takanashi Seiji, Ikegami Shota, Kato Hiroyuki, Saito Naoto
Department of Orthopedic Surgery (K.T., Y.A., H.S., S.T., S.I., and H.K.) and Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research (N.S.), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan. E-mail address for K. Tensho:
J Bone Joint Surg Am. 2015 Sep 2;97(17):1441-8. doi: 10.2106/JBJS.N.01313.
The tibial tuberosity-trochlear groove distance is used as an indicator for medial tibial tubercle transfer; however, to our knowledge, no studies have verified whether this distance is strongly affected by tubercle lateralization at the proximal part of the tibia. We hypothesized that the tibial tuberosity-trochlear groove distance is mainly affected by tibial tubercle lateralization at the proximal part of the tibia.
Forty-four patients with a history of patellar dislocation and forty-four age and sex-matched controls were analyzed with use of computed tomography. The tibial tuberosity-trochlear groove distance, tibial tubercle lateralization, trochlear groove medialization, and knee rotation were measured and were compared between the patellar dislocation group and the control group. The association between the tibial tuberosity-trochlear groove distance and three other parameters was calculated with use of the Pearson correlation coefficient and partial correlation analysis.
There were significant differences in the tibial tuberosity-trochlear groove distance (p < 0.001) and knee rotation (p < 0.001), but there was no difference in the tibial tubercle lateralization (p = 0.13) and trochlear groove medialization (p = 0.08) between the patellar dislocation group and the control group. The tibial tuberosity-trochlear groove distance had no linear correlation with tubercle lateralization (r = 0.21) or groove medialization (r = -0.15); however, knee rotation had a good positive correlation in the patellar dislocation group (r = 0.62). After adjusting for the remaining parameters, knee rotation strongly correlated with the tibial tuberosity-trochlear groove distance (r = 0.69, p < 0.001), whereas tubercle lateralization showed moderate significant correlations in the patellar dislocation group (r = 0.42; p = 0.005).
Because the tibial tuberosity-trochlear groove distance is affected more by knee rotation than by tubercle malposition, its use as an indicator for tibial tubercle transfer may not be appropriate.
Surgical decisions of tibial tubercle transfer should be made after the careful analysis of several underlying factors of patellar dislocation.
胫骨结节 - 滑车沟距离被用作内侧胫骨结节转移的指标；然而，据我们所知，尚无研究证实该距离是否会受到胫骨近端结节外侧化的强烈影响。我们假设胫骨结节 - 滑车沟距离主要受胫骨近端结节外侧化的影响。
对44例有髌骨脱位病史的患者以及44例年龄和性别匹配的对照者进行计算机断层扫描分析。测量了胫骨结节 - 滑车沟距离、胫骨结节外侧化、滑车沟内侧化和膝关节旋转情况，并在髌骨脱位组和对照组之间进行比较。使用Pearson相关系数和偏相关分析计算胫骨结节 - 滑车沟距离与其他三个参数之间的关联。
髌骨脱位组和对照组在胫骨结节 - 滑车沟距离（p < 0.001）和膝关节旋转（p < 0.001）方面存在显著差异，但在胫骨结节外侧化（p = 0.13）和滑车沟内侧化（p = 0.08）方面无差异。胫骨结节 - 滑车沟距离与结节外侧化（r = 0.21）或沟内侧化（r = -0.15）无线性相关性；然而，在髌骨脱位组中膝关节旋转具有良好的正相关性（r = 0.62）。在对其余参数进行校正后，膝关节旋转与胫骨结节 - 滑车沟距离密切相关（r = 0.69，p < 0.001），而在髌骨脱位组中结节外侧化显示出中度显著相关性（r = 0.42；p = 0.005）。
由于胫骨结节 - 滑车沟距离受膝关节旋转的影响大于结节位置异常的影响，因此将其用作胫骨结节转移的指标可能不合适。
胫骨结节转移的手术决策应在仔细分析髌骨脱位的几个潜在因素后做出。
