Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance
Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance
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DOI：
10.1007/s00167-017-4527-5
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发表时间：
2018-03-01
影响因子：
3.8
通讯作者：
Arendt, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Graf, Kristin H.;Tompkins, Marc A.;Arendt, Elizabeth A.
外侧股四头肌矢量增加与外侧髌骨脱位有关。当股四头肌矢量“过大”时，通常建议通过胫骨结节内侧化对增加的矢量进行手术矫正。这可以通过体格检查测量q角和/或结节沟角（TSA）以及磁共振成像（MRI）测量胫骨结节-滑车沟（TT-TG）距离来评估。本研究检测了股四头肌外侧矢量（TT-TG， q角，TSA）的三个客观测量之间的关系。第二个目的是将外侧髌骨倾斜与这些测量联系起来。纳入2010年9月至2011年6月连续接受髌骨股骨稳定手术的患者。术中体格检查测量q角和TSA。MRI测量TT-TG和髌骨倾斜度。使用Pearson相关系数将TSA、q角和髌骨倾斜与TT-TG进行比较。研究队列包括49例患者，年龄12-37岁（平均23.2岁）；62%的女性。TT-TG与TSA、q角的Pearson相关系数均呈（+）显著性（p < 0.01）。Tilt和TT-TG呈（+）不显著相关。尽管每项测量与TT-TG呈正相关，但患者内部相关性并不统一。换句话说，如果患者的TT-TG升高，则不能保证该患者的所有其他测量值（包括倾斜度）都升高。髌骨不稳手术患者TT-TG距离与TSA、q角测量值有显著正相关。临床相关性是，个体患者的可变性表明需要在手术干预前和手术期间考虑TSA和TT-TG，以避免内侧胫骨结节截骨矫治过度。诊断研究，III级。
An increased lateral quadriceps vector has been associated with lateral patellar dislocation. Surgical correction of this increased vector through tibial tubercle medialization is often recommended when the quadriceps vector is "excessive". This can be evaluated by physical examination measurements of Q-angle and/or tubercle sulcus angle (TSA), as well as the magnetic resonance imaging (MRI) measurement of tibial tubercle-trochlear groove (TT-TG) distance. This study examined the relationship between three objective measurements of lateral quadriceps vector (TT-TG, Q-angle, TSA). A secondary goal was to relate lateral patellar tilt to these measurements.Consecutive patients undergoing patellofemoral stabilization surgery from 9/2010 to 6/2011 were included. The Q-angle and TSA were measured on intra-operative physical examination. The TT-TG and patellar tilt were measured on MRI. TSA, Q-angle, and patellar tilt were compared to TT-TG using Pearson correlation coefficient.The study cohort included 49 patients, ages 12-37 (mean 23.2); 62% female. The Pearson correlation coefficients showed (+) significance (p < 0.01) between the TT-TG and both TSA and Q-angle. Tilt and TT-TG were (+) non-significantly correlated. Despite positive correlations of each measurement with TT-TG, there is not uniform intra-patient correlation. In other words, if TT-TG is elevated for a patient, it does not guarantee that all other measurements, including tilt, are elevated in that individual patient.The TT-TG distance has significant positive correlation with the measurements of TSA and Q-angle in patients undergoing surgery for patellofemoral instability. The clinical relevance is that the variability within individual patients demonstrates the need for considering both TSA and TT-TG before and during surgical intervention to avoid overcorrection with a medial tibial tubercle osteotomy.Diagnostic study, Level III.