髌骨股骨不稳的手术治疗:扭转和冠状错位的截骨术

IF 0.2 Q4 ORTHOPEDICS
Alan Katz MD, Peter Staunton FRCS (T&O), Mitchell Bernstein MD
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引用次数: 0

摘要

髌骨股骨不稳(PFI)是一种普遍存在的骨科问题,会导致严重的发病率和功能限制。髌骨股骨不稳的发病率很高,尤其是青少年女性,复发率在 17% 到 33% 之间。复发性 PFI 会大大增加退行性病变和早发性骨关节炎的风险。具有多种风险因素的患者复发率明显增加,因此识别和管理解剖学风险因素是患者的有效策略。这些因素包括:髋臼发育不良、髌骨突出、胫骨结节与髋臼沟(TT-TG)间距增大、股骨内翻、胫骨外翻和肢体外翻。本研究概述了针对与扭转或冠状位不正相关的 PFI 的综合评估和手术方法。评估包括详细的病史、临床检查和诊断成像。根据不稳定性的具体病理解剖选择算法方法进行手术干预,重点是骨骼和软组织手术。针对存在错位的 PFI 的手术技术包括近端和远端骨性手术。本研究详细介绍的具体技术包括髓内钉上的股骨扭转截骨术、股骨远端开合楔形截骨术以及用髓内钉或钢板固定的胫骨扭转截骨术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Operative Treatment of Patellofemoral Instability: Osteotomies for Torsional and Coronal Malalignment

Patellofemoral instability (PFI) is a prevalent orthopedic issue that leads to significant morbidity and functional limitation. It has a notable incidence, specifically higher amongst adolescent females, and a recurrence rate ranging from 17% to 33%. Recurrent PFI significantly increases the risk of degenerative changes and early-onset osteoarthritis. Patients with multiple risk factors have a remarkably increased rate of recurrence, and thus identifying and managing anatomical risk factors is an effective strategy for patients. These include: trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, increased femoral anteversion, external tibial torsion, and valgus limb alignment. This study outlines a comprehensive evaluation and surgical approach focusing on PFI associated with torsional or coronal malalignments. The evaluation includes a detailed patient history, clinical examination, and diagnostic imaging. Surgical interventions are selected based on an algorithmic approach tailored to the specific pathoanatomy of the instability, focusing on both bony and soft-tissue procedures. Surgical techniques for addressing PFI in the presence of malalignment include proximal and distal bony procedures. Specific techniques detailed in this study include femoral torsional osteotomy over an intramedullary nail, distal femur opening and closing wedge osteotomies, and torsional tibial osteotomies fixated with an intramedullary nail or plate.

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来源期刊
CiteScore
0.40
自引率
0.00%
发文量
40
审稿时长
83 days
期刊介绍: Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty.
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