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目的探讨骨骺未闭的青少年膝内侧髌股韧带重建术中股骨隧道定位变化对移植物等距特性的影响。方法选择2015年6月-2016年10月新疆医科大学第一附属医院骨肿瘤科收治的16岁以下骨骺未闭的青少年患者共10例20膝,分别行0°、30°、60°三维CT重建,以Schttle确定的股骨侧定位点为基点G,分别取G点上方5mm为点A,A点前方5mm为点B,A点上方5mm为点C,G点下方5mm为点D,D点前方5mm为点E,G点下方1cm为点F点,取髌骨内侧缘近端1/3为O点。分别测量不同角度下相对应各点的长度,记为OA、OB、OC、OD、OE、OF、OG。结果膝关节屈曲0°、30°、60°时,变化长度最短的为OG(2.4±1.4)mm,变化长度最长的为OC(7.6±2.7)mm;两两比较中,OA的变化长度[(3.2±1.2)mm]和OB变化长度[(3.6±1.3)mm]差异无统计学意义(P>0.05),其余各股骨定位点比较差异均有统计学意义(P<0.05)。相同股骨定位点在不同角度所得长度变化平均值差异均有统计学意义(P<0.05)。股骨定位点在0°位时OF的长度最长[(56.3±2.4)mm],OC的长度最短[(45.5±2.4)mm];股骨定位点在60°时OC的长度最长[(56.3±2.1)mm],OE点最短[(45.2±2.1)mm]。结论对于骨骺未闭的青少年膝关节MPFL重建术中,股骨侧定位点选择在G、A、B 3点之间的区域可提供正常的膝关节生物力学功能。
Objective To investigate the effect of femoral tunnel positioning changes on the isograft characteristics of grafts in patients with epiphyseal uncapitalized adolescent during medial patellofemoral ligament reconstruction. METHODS: From June 2015 to October 2016, 10 young patients with epiphysis who under 16 years of age were admitted to Department of Oncology, the First Affiliated Hospital of Xinjiang Medical University were treated with 0 °, 30 °, 60 ° three-dimensional CT Reconstruction to Schttle to determine the femoral side of the positioning point for the base G, respectively, take the top of the G 5mm point A, A point 5mm in front of the point B, A point above the 5mm point C, G point 5mm below the point D, 5mm in front of point D is point E, 1cm below point G is point F, and 1/3 of the medial edge of patella is point O. Measure the length of each point corresponding to different angles, denoted as OA, OB, OC, OD, OE, OF, OG. Results When the knee joint flexed at 0 °, 30 ° and 60 °, the shortest change length was OG (2.4 ± 1.4) mm, and the longest change length was OC (7.6 ± 2.7) mm. There was no significant difference in the length of [(3.2 ± 1.2) mm] and length of OB [(3.6 ± 1.3) mm] (P> 0.05). The average change of the length of the same femur fixed point at different angles was statistically significant (P <0.05). The length of OF was the longest (56.3 ± 2.4) mm in 0 ° position and the length of OC was the shortest [(45.5 ± 2.4) mm]; the length of OC was the longest in femur locating at 60 ° (56.3 ± 2.1) mm], the shortest OE point [(45.2 ± 2.1) mm]. CONCLUSIONS: In the MPFL reconstruction of epiphysis-free adolescent knee joint, the selection of the femoral locating point in the region between G, A and B points can provide normal knee biomechanical function.