引入胫骨外侧高度增加和内侧半月板骨角减小作为复发性髌骨脱位的独立危险因素
简介
本研究通过MRI测量，评估了胫骨平台及半月板几何形态与成人复发性髌骨脱位（RPD）的关联。研究发现，RPD患者的外侧胫骨后倾角（LTS）减小、外侧胫骨高度（LTH）增加、内侧半月板骨角（MMBA）减小、胫骨结节-股骨滑车间距（TT-TG）增加及胫股角（TFA）改变。多因素分析进一步确认，**LTH增加和MMBA减小是独立于TT-TG和TFA的RPD风险因素*…
英文摘要
BACKGROUND: Tibiofemoral rotational malalignment, recognized as a risk factor for recurrent patellar dislocation (RPD), has become a research focus. Although the relationship between femoral morphology and RPD is widely studied, the association between RPD and the tibial plateau and meniscus geometries related to the tibiofemoral rotation remains unexamined. HYPOTHESIS: After accounting for the classic risk factors associated with knee rotation-tibial tuberosity-trochlear groove (TT-TG) distance and tibiofemoral angle (TFA)-targeted anatomical parameters are independently associated with adult RPD. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: This retrospective case-control study included 50 adult patients with RPD and 50 age-, sex-, and body mass index-matched controls. Knee magnetic resonance imaging scans were used to assess parameters-including the lateral tibial slope (LTS), medial tibial slope (MTS), lateral tibial height (LTH), medial tibial depth (MTD), medial meniscal bone angle (MMBA), MTS-LTS (slope difference), MTS: LTS ratio, MTS: MMBA ratio, TT-TG distance, and TFA. Differences among groups were compared; a multivariate logistic regression model was created to evaluate independent factors, and the diagnostic performance of the substantial risk factors, individually and in combination, was assessed. RESULTS: The LTS (P = .002), LTH (P < .001), MMBA (P < .001), MTS-LTS (P = .001), MTS: LTS ratio (P = .001), TT-TG distance (P < .001), and TFA (P < .001) were found to be significantly different between the groups. Logistic regression analysis identified the LTH (odds ratio [OR], 0.409; P = .014), MMBA (OR, 1.456; P < .001), and TT-TG distance (OR, 0.752; P ≤ .001) as independent adult RPD risk factors. Receiver operating characteristic analysis showed that combining LTH, MMBA, and TT-TG distance had excellent predictive ability for adult RPD, with an area under the curve (AUC) of 0.888, sensitivity of 82%, and specificity of 88%, surpassing their diagnostic values (AUCs, 0.694-0.804). CONCLUSION: The decreased LTS, increased LTH, decreased MMBA, increased MTS-LTS, and increased MTS: LTS ratio were associated with adult RPD. Importantly, even after controlling for TT-TG distance and TFA, increased LTH and decreased MMBA persisted as independent risk factors for adult RPD.