Li Junran, Chen Chuanjie, Zhou Hongyan, Zhai Jingxiu, Zhao Hongbo, Li Ligeng
Department of Orthopedic Surgery, Second Hospital of Tangshan, Tangshan 063000, Hebei, China.
Institute of Trauma Surgery, Second Hospital of Tangshan, Tangshan 063000, Hebei, China.
Evid Based Complement Alternat Med. 2022 Aug 8;2022:6723326. doi: 10.1155/2022/6723326. eCollection 2022.
To analyze the risk factors for osteochondral fracture (OCF) of first-time acute patellar dislocation (APD) through measurements of patellofemoral anatomy in adolescents.
In this prospective study, all patients were divided into two groups according to whether OCF was detected on magnetic resonance imaging (MRI): Group A (associated with OCF) and Group B (without OCF). Patellofemoral anatomy was evaluated with four aspects including trochlear/patellar dysplasia, patella location, patellofemoral matching, and morphologic classification. On MRI scans, trochlear facet asymmetry ratio (TFAR), lateral trochlear inclination (LTI), sulcus angle (SA), trochlear depth (TD), and patellar depth (PD) were measured to assess trochlear/patellar dysplasia. Insall-Salvati index (ISI), Caton-Deschamps index (CDI), Blackburne-Peel index (BPI), lateral patellofemoral angle (LPFA), patellar tilt angle (PTA), and lateral patellar displacement (LPD) were measured to show the location of patella. Patellofemoral matching was analyzed through the measurements of patellofemoral congruence angle (PFCA), patellofemoral index (PFI), and patellotrochlear index (PTI).
A total of ninety-four adolescents from 49 boys and 45 girls (mean age, 15 years; range, 10-18 years) with first-time APD were recruited and included in Group A (65) and Group B (29). The PFI (2.62 ± 0.51 . 2.10 ± 0.44) and PTI (0.28 ± 0.05 . 0.22 ± 0.07) were significantly higher in Group B than Group A ( < 0.05). There were no significant differences in other quantitative outcomes of the two groups ( > 0.05). The distribution of Dejour/Wiberg classification was statistically similar between the two groups ( > 0.05).
Adolescent patients with first-time APD complicating OCF have closer morphologic features of patellofemoral dysplasia and patella location when compared to adolescents without OCF. Abnormal patellofemoral matching increases the risk of OCF after first-time APD in adolescents.
通过测量青少年髌股关节解剖结构，分析首次急性髌骨脱位（APD）合并骨软骨骨折（OCF）的危险因素。
在这项前瞻性研究中，所有患者根据磁共振成像（MRI）检查是否发现OCF分为两组：A组（合并OCF）和B组（未合并OCF）。从滑车/髌骨发育异常、髌骨位置、髌股匹配及形态学分类四个方面评估髌股关节解剖结构。在MRI扫描中，测量滑车沟不对称率（TFAR）、外侧滑车倾斜度（LTI）、沟角（SA）、滑车深度（TD）和髌骨深度（PD）以评估滑车/髌骨发育异常。测量Insall-Salvati指数（ISI）、Caton-Deschamps指数（CDI）、Blackburne-Peel指数（BPI）、外侧髌股角（LPFA）、髌骨倾斜角（PTA）和髌骨外侧移位（LPD）以显示髌骨位置。通过测量髌股适合角（PFCA）、髌股指数（PFI）和髌股关节指数（PTI）分析髌股匹配情况。
共纳入94例首次发生APD的青少年患者，其中男性49例，女性45例（平均年龄15岁；范围10 - 18岁），分为A组（65例）和B组（29例）。B组的PFI（2.62±0.51. 2.10±0.44）和PTI（0.28±0.05. 0.22±0.07）显著高于A组（<0.05）。两组其他定量指标差异无统计学意义（>0.05）。两组间Dejour/Wiberg分类分布差异无统计学意义（>0.05）。
与未合并OCF的青少年相比，首次发生APD合并OCF的青少年患者髌股发育异常和髌骨位置的形态学特征更相近。髌股匹配异常增加了青少年首次发生APD后发生OCF的风险。
