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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?
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Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?

机译：骨骼未成熟患者的滑车发育不良的当前分类和影像学测量是否合适？

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Background: The assessment and classification of trochlear dysplasia in pediatric patients has yet to be well documented or validated. Purpose: To examine several different measurements/classifications of trochlear dysplasia in skeletally immature patients to assess inter- and intraobserver reliability and to determine which best correlates with patellar instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Radiographs and magnetic resonance imaging (MRI) scans of 36 skeletally immature patients undergoing surgery for patellar instability were compared with 27 age-matched cohort patients who had similar imaging for an acute knee injury but no clinical evidence of patellar instability. Trochlear dysplasia was measured/classified using the radiographic and MRI Dejour classifications, the trochlear depth index (TDI), the lateral trochlear inclination (LTI), and the medial condyle trochlear offset (MCTO). Additionally, the tibial tubercle–trochlear groove (TT-TG) distance was calculated for all patients. Inter- and intraobserver reliability of each measurement, as well as the ability to discriminate patients with patellar instability, were evaluated. Results: Inadequate radiographs prevented the radiographic Dejour classification from being assessed in 78% of cases. The MRI Dejour classification had the lowest inter- and intraobserver reliabilities (κ = 0.687 and 0.596, respectively); all other measurements were greater than 0.80. The TDI, LTI, and MCTO all significantly differentiated patients with patellar instability compared with those with no instability, with critical cutoffs of 3 mm, 17°, and 1 mm, respectively. Patients with a TDI <3 mm or MCTO <1 mm were 33 and 38 times more likely to have patellar instability, respectively. The TT-TG was directly correlated with trochlear dysplasia severity. Conclusion: Trochlear dysplasia is common in skeletally immature patients with patellar instability. The objective assessment of trochlear dysplasia with axial imaging MRI is reliable. The objective measurements of TDI, LTI, and MCTO are more reproducible than the more subjective Dejour classification. The TDI, LTI, and MCTO all significantly differentiated patients with patellar instability.
机译：背景：小儿滑车发育不良的评估和分类尚未得到充分证明或证实。目的：检查骨骼未成熟患者中滑车发育不良的几种不同测量/分类，以评估观察者间和观察者内的可靠性，并确定哪种与best骨不稳定性最相关。研究设计：队列研究（诊断）;证据等级，3。方法：比较了36例因pa骨不稳而接受手术的骨骼未成熟患者的X线照片和磁共振成像（MRI）扫描结果，以及27例年龄相近的队列研究，这些患者对急性膝关节损伤具有类似的成像，但无临床证据tell骨不稳定。使用放射学和MRI Dejour分类，滑车深度指数（TDI），滑车外侧倾度（LTI）和con内侧滑车偏移（MCTO）对滑车发育不良进行测量/分类。此外，还计算了所有患者的胫骨小结节至小车槽（TT-TG）的距离。评估了每次测量的观察者之间和观察者内部的可靠性，以及辨别pa骨不稳定患者的能力。结果：X射线照片不足，导致78％的病例无法评估X射线摄影的分类。 MRI Dejour分类法在观察者之间和观察者内部的可靠性最低（分别为κ= 0.687和0.596）;所有其他测量值均大于0.80。与没有，骨不稳定的患者相比，TDI，LTI和MCTO均能显着区分with骨不稳定的患者，临界临界值分别为3 mm，17°和1 mm。 TDI <3 mm或MCTO <1 mm的患者发生pa骨不稳的可能性分别为33和38倍。 TT-TG与滑车发育不良的严重程度直接相关。结论：骨骼不成熟的Tro骨不稳患者常见于滑车不典型增生。轴向成像MRI对滑车发育不良的客观评估是可靠的。与更主观的Dejour分类相比，TDI，LTI和MCTO的客观度量更具可重复性。 TDI，LTI和MCTO均能明显区分with骨不稳的患者。

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