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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Quantification Of Trochlea Dysplasia Via Computed Tomography: Assessment Of Morphology Difference Between Control And Chronic Patellofemoral Instability Patients
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Quantification Of Trochlea Dysplasia Via Computed Tomography: Assessment Of Morphology Difference Between Control And Chronic Patellofemoral Instability Patients

机译：通过计算机体层摄影术对滑车发育不良的量化：对照和慢性Pat股不稳患者之间形态差异的评估

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Objectives: Trochlear dysplasia is an important risk factor for the development of recurrent patella instability. Owing to its complex 3-Dimensional morphology, the need for a true lateral radiograph, and poor inter-observer reliability, the Dejour classification system of dysplasia may not be the most optimal measure for quantification. The purpose of this study is to report a novel technique to define and quantify the trochlea volume and length using an axial computed tomography. This technique was applied to a series of patients surgically treated for recurrent patellofemoral instability and the measurements compared to a control group. Methods: From 2007 to 2013, 99 control patients (136 knees) were identified from trauma CT scans obtained during admission at our Level I trauma hospital. Patients older than 35y/o or with fractures in the distal femur were excluded. Axial cuts at 1.25 mm were used to measure trochlea volume; defined to be from the physeal scar to the final axial image in which the sulcus could be visualized (Figure 1). Trochlear groove distance was measured from a midline sagittal reformatted image perpendicular to the posterior margin of the femoral condyles. The inter-observer reliability was assessed with independent measurements from attending orthopedist, MSK radiologist and two senior residents. Dysplasia patient cohort was a series of 35 patients (70knees) who were surgically treated for recurrent instability, by AAS or CME, from 2007-2013 and a diagnosis of dysplasia based on lateral knee radiograph. CT tracking studies are obtained from bilateral knees as a normal part of our pre-operative assessment. Institutional IRB approval was obtained for data retrieval. Results: Control cohort average age 25 +/- 4 years, 68 M:31F, without documented history of patella instability on chart review. Dysplastic cohort average age 24 +/- 5 years, 2 M:33F, all 35 patients had bilateral knees scanned. Statistically significant differences were noted in comparing the trochlea volume (3.75 +/- 0.97 cm3 vs. 2.0+/- 0.56 cm3) and the trochlea length (34.8 +/- 4.9 mm vs. 31.7 +/- 4.2 mm) between control and dysplastic cohorts respectively. Comparing female only patients demonstrated difference in trochlea volume (2.89 +/- 0.57 cm3 vs. 2.0+/- 0.36 cm3), but not trochlea length (31.7 +/- 2.5 mm vs. 31.7 +/- 2.7 mm). No difference in trochlea volume or length b/w symptomatic knee to asymptomatic contralateral knees in patients with recurrent instability (2.31 cm3 vs. 2.24 cm3) and (30.0 mm vs. 30.5 mm). Inter-observer reliability was assess measuring trochlea volume: ICC for Right Trochlea: 0.98, ICC Left Trochlea: 0.97. Conclusion: This novel technique clearly defines and quantifies the trochlea morphology into volume and length values with high ICC values. Applying this technique demonstrates a significant difference in both trochlea volume and length between a control group and patients treated for recurrent patellofemoral instability.
机译：目的：滑车不典型增生是复发性骨不稳的重要危险因素。由于其复杂的三维形态，需要真实的侧位X射线照相以及观察者之间的可靠性差，异型增生的Dejour分类系统可能不是量化的最佳方法。这项研究的目的是报告一种使用轴向计算机断层扫描技术定义和量化滑车体积和长度的新技术。将该技术应用于一系列经手术治疗的pa股复发性不稳定性患者，并与对照组进行比较。方法：从2007年至2013年，我们在一级创伤医院就诊期间通过创伤CT扫描确定了99例对照患者（136膝）。年龄大于35y / o或股骨远端骨折的患者被排除在外。 1.25mm的轴向切口用于测量滑车的体积。定义为从脉络膜瘢痕到最终可视化的沟渠影像（图1）。从垂直于股骨dy后缘的中线矢状重组图像测量滑车沟距离。观察者之间的可靠性通过与主治骨科医生，MSK放射科医生和两名高级住院医师的独立测量来评估。异型增生患者队列是从2007年至2013年通过AAS或CME接受手术治疗的复发性不稳定性的35例患者（70膝），并根据膝关节侧位X线照片诊断为异型增生。 CT追踪研究是从双侧膝盖获得的，这是我们术前评估的正常部分。已获得机构IRB批准进行数据检索。结果：对照组队列平均年龄为25 +/- 4岁，年龄为68 M：31F，在图表检查中未记录in骨不稳定的病史。发育不良的队列平均年龄为24 +/- 5岁，2 M：33F，所有35例患者均进行了双侧膝盖扫描。比较对照和发育不良之间的滑车容积（3.75 +/- 0.97 cm3对2.0 +/- 0.56 cm3）和滑车长度（34.8 +/- 4.9 mm对31.7 +/- 4.2 mm），在统计学上有显着差异。队列。仅女性患者进行比较时，显示出滑车容积的差异（2.89 +/- 0.57 cm3对2.0 +/- 0.36 cm3），但没有滑车长度的差异（31.7 +/- 2.5 mm对31.7 +/- 2.7 mm）。复发性不稳定患者（2.31 cm3 vs. 2.24 cm3）和（30.0 mm vs. 30.5 mm）的患者的滑车容积或症状患者的b / w长度与无症状对侧膝盖无差异。观察者间的可靠性是通过测量滑车的体积来评估的：右滑车的ICC：0.98，左滑车的ICC：0.97。结论：这项新技术清楚地将滑车形态定义和量化为具有高ICC值的体积和长度值。应用该技术表明，对照组和接受治疗的pa股复发性不稳定患者的滑车体积和长度均存在显着差异。

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