摘要
目的:探讨复发性髌骨不稳MRI测量的影响因素及其预测价值。方法:选择初次髌骨脱位采取保守治疗并确诊为复发性髌骨不稳的患者57例,定义为复发组;另选择初次髌骨脱位采取保守治疗但未出现复发性髌骨不稳的患者60例,定义为对照组。导出MRI图像后进行测量,测量指标包括髌骨偏移指数(BSO)、滑车适合角(CA)、髌骨倾斜角(PTA)、股骨外侧滑车倾斜角(LTI)、股骨滑车面对称性、滑车沟角度(SA)、股骨滑车深度、胫骨结节-股骨滑车沟距离(TT-TG)、髌韧带长度与髌骨最长径之比(ISR)、髌骨后下缘至胫骨平台前方距离与髌骨后缘长径之比(C-D)。采用多因素Logistic回归分析复发性髌骨不稳的影响因素,建立受试者工作特征(ROC)曲线分析潜在测量指标预测复发性髌骨不稳的准确性并探讨联合指标预测复发性髌骨不稳的价值。结果:多因素Logistic回归分析结果显示LTI(P=0.048)、ISR(P=0.000)和TT-TG(P=0.025)是复发性髌骨不稳的独立影响因素。ISR预测的准确度最高(AUC=0.891),显著高于TT-TG和LTI(AUC分别为0.785和0.676),差异有统计学意义(P<0.05)。三项测量指标(LTI、ISR和TT-TG)联合预测复发性髌骨不稳的准确性最高(AUC=0.938),显著高于三项测量指标单独预测复发性髌骨不稳的AUC(P<0.05),其敏感度为91.23%,特异度为83.33%。结论:ISR、LTI和TT-TG三项测量指标联合预测能准确评估初次髌骨脱位后复发性髌骨不稳的发生风险。
Objective: To analyze the influencing factors of MRI of recurrent patella instability and explore their predictive value. Methods: A total of fifty-seven patients with recurrent patella instability who underwent conservative treatment in primary patella dislocation were enrolled in recurrence group.60 patients without recurrent patella instability after conservative treatment in primary patella dislocation were enrolled in the control group.Measurements were performed after exporting MRI images.The measurement parameters included tibial offset index (BSO),trochlear congruence angle (CA),patellar tilt angle (PTA),lateral trochlear inclination (LTI),trochlear facet asymmetry,sulcus angle (SA),trochlear depth,tibial tuberosity-trochlear groove distance (TT-TG),insall-salvati ratio (ISR),caton-deschamps index (CD).Multivariate logistic regression was used to analyze the influencing factors of recurrent patella instability.The accuracy of ROC curve analysis for predicting recurrent patella instability was established and the value of combined indicators to predict recurrent patella instability was explored. Results: Multivariate logistic regression analysis showed that LTI ( P = 0.048), ISR ( P =0.000) and TT-TG ( P =0.025) were independent influencing factors of recurrent patella instability.The prediction accuracy of ISR was the highest (AUC=0.891),which was significantly higher than the AUC of TT-TG and LTI ( P <0.05).The combination of three MRI measurements predicting the recurrence of patella instability were the most accurate (AUC=0.938),which was significantly higher than AUC ( P <0.05).The sensitivity was 91.23%,and the specificity was 83.33%. Conclusion: The combination of ISR,LTI and TT-TG can accurately assess the recurrence of patella instability after primary patella dislocation.
作者
曹慧芳
李慧明
刘璐
杨慧敏
CAO Hui-fang;LI Hui-ming;LIU Lu(Department of Radiology,Guangdong Province Public Security Frontier General Hospital,Shenzhen 518029,China)
出处
《放射学实践》
北大核心
2019年第9期1024-1028,共5页
Radiologic Practice
关键词
髌骨不稳
髌骨脱位
磁共振成像
影响因素分析
预测
Patella instability
Patellar Dislocation
Magnetic resonance imaging
Root Cause Analysis
Forecasting
