髌股韧带股骨止点形态及鞍状沟的计算机断层扫描成像分析：对1094例膝关节的评估
Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees.
作者信息
Chen Jiebo, Xiong Yijia, Han Kang, Xu Caiqi, Cai Jiangyu, Wu Chenliang, Ye Zipeng, Zhao Jinzhong, Xie Guoming
机构信息
Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
出版信息
Orthop J Sports Med. 2022 Feb 8;10(2):23259671211073608. doi: 10.1177/23259671211073608. eCollection 2022 Feb.
BACKGROUND
The medial patellofemoral ligament (MPFL) has been reported to be anatomically attached from an osseous saddle region (saddle sulcus) between neighboring landmarks on the femur, including the adductor tubercle (AT), medial epicondyle (ME), and medial gastrocnemius tubercle (MGT). However, the position and prevalence of the saddle sulcus remain unknown.
PURPOSE
To study the femoral footprint of MPFL and the prevalence of the saddle sulcus with computed tomography (CT) imaging; quantify the position of the saddle sulcus; and determine the relevant factors of the identified position and measuring distances.
STUDY DESIGN
Cross-sectional study; Level of evidence, 3.
METHODS
A total of 1094 knees in 753 patients were studied. Knees were organized into an anterior cruciate ligament reconstruction (ACLR) group (controls) and a recurrent patellar dislocation (RPD) group. Using 3-dimensionally reconstructed CT images, the authors determined the prevalence of the saddle sulcus and its position relative to the AT, the ME, the Schöttle point (1.3 mm anterior to the distal posterior cortex and 2.5 mm distal to the posterior origin of the medial femoral condyle), and the Fujino point (approximately 10 mm distal to the AT). Analysis of covariance was used to adjust for age, sex, side, and body mass index on the measurements.
RESULTS
There were 555 knees in the control group and 539 knees in the RPD group. The MPFL femoral footprint presented as an oblique, oblong, osseous region (saddle sulcus) in 75.7% of knees (75.0%, ACLR group vs 76.4%, RPD group; < .001). The saddle sulcus was located a mean of 12.2 mm (95% CI, 12.0-12.4 mm) from a line connecting the apex of the AT to the ME (AT-ME) and a mean of 7.6 mm (95% CI, 7.5-7.8 mm) posteriorly perpendicular to that line. The location as a proportion of the AT-ME distance was 63.1% (95% CI, 62.6%-63.7%) in the direction and 39.8% (95% CI, 39.1%-40.5%) in the direction. The Schöttle and Fujino points lay anterior and proximal to the saddle sulcus more than 5 mm away from the center of the saddle sulcus. Women had a higher prevalence of saddle sulcus (odds ratio [OR], 1.33 [95% CI, 1.00-1.75]; = .046) compared with men.
CONCLUSION
The saddle sulcus was identified in 75.7% of knees from the medial femoral aspect, with its center located consistently between the AT and ME.
背景
据报道，髌股内侧韧带（MPFL）在股骨上的附着点位于相邻标志之间的一个骨性鞍状区域（鞍状沟），这些标志包括内收肌结节（AT）、内侧髁（ME）和腓肠肌内侧头结节（MGT）。然而，鞍状沟的位置和发生率仍然未知。
目的
通过计算机断层扫描（CT）成像研究MPFL在股骨上的附着区域以及鞍状沟的发生率；量化鞍状沟的位置；并确定所确定位置和测量距离的相关因素。
研究设计
横断面研究；证据等级，3级。
方法
对753例患者的1094个膝关节进行了研究。将膝关节分为前交叉韧带重建（ACLR）组（对照组）和复发性髌骨脱位（RPD）组。作者使用三维重建的CT图像，确定了鞍状沟的发生率及其相对于AT、ME、朔特勒点（股骨远端后皮质前方1.3 mm，股骨内侧髁后缘远端2.5 mm）和藤野点（AT远端约10 mm）的位置。采用协方差分析对测量中的年龄、性别、侧别和体重指数进行校正。
结果
对照组有555个膝关节，RPD组有539个膝关节。在75.7%的膝关节中，MPFL在股骨上的附着区域呈现为一个倾斜的、椭圆形的骨性区域（鞍状沟）（75.0%，ACLR组 vs 76.4%，RPD组；P <.001）。鞍状沟距连接AT顶点与ME的直线（AT-ME）平均为12.2 mm（95%CI，12.0 - 12.4 mm），垂直于该直线向后平均为7.6 mm（95%CI，7.5 - 7.8 mm）。在AT-ME距离方向上，其位置占比为63.1%（95%CI，62.6% - 63.7%），在垂直方向上为39.8%（95%CI，39.1% - 40.5%）。朔特勒点和藤野点位于鞍状沟前方和近端，距离鞍状沟中心超过5 mm。与男性相比，女性鞍状沟的发生率更高（优势比[OR]，1.33[95%CI，1.00 - 1.75]；P = 0.046）。
结论
在内侧股骨面75.7%的膝关节中发现了鞍状沟，其中心始终位于AT和ME之间。
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