Brunet Michael E, Brinker Mark R, Cook Stephen D, Christakis Petros, Fong Brian, Patron Laura, O'Connor Daniel P
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Clin Orthop Relat Res. 2003 Sep(414):266-75. doi: 10.1097/01.blo.0000079266.91782.11.
The current study compared patella tracking during simulated concentric and eccentric quadriceps contractions in 12 knees from cadavers using a three-dimensional electromagnetic tracking system. The patella shifted (translated) and tilted medially during approximately the initial 22 degrees tibiofemoral flexion. The patella then shifted and tilted laterally for the remaining arc of tibiofemoral flexion (90 degrees). At 90 degrees tibiofemoral flexion, the patella had an orientation of lateral patella shift and lateral patella tilt. Patella shift was significantly more lateral between 40 degrees and 70 degrees tibiofemoral flexion during concentric quadriceps action than during eccentric contraction. Patella tilt was significantly more lateral between 45 degrees and 55 degrees tibiofemoral flexion during concentric quadriceps contraction than during eccentric action. No other significant differences were seen between the quadriceps contraction conditions. The current study supports the hypothesis that patellar instability is most likely a result of various anatomic and physiologic factors causing a failure of the extensor mechanism to deliver the patella into the femoral sulcus and that a patellar dislocation rarely would occur in a normal knee.
本研究使用三维电磁跟踪系统，比较了12具尸体膝关节在模拟股四头肌向心收缩和离心收缩过程中的髌骨轨迹。在大约最初的22度胫股关节屈曲过程中，髌骨向内移位（平移）并倾斜。然后，在胫股关节屈曲的其余弧度（90度）中，髌骨向外移位并倾斜。在胫股关节屈曲90度时，髌骨呈现外侧移位和外侧倾斜的方向。在股四头肌向心收缩过程中，胫股关节屈曲40度至70度时的髌骨移位明显比离心收缩时更偏向外侧。在股四头肌向心收缩过程中，胫股关节屈曲45度至55度时的髌骨倾斜明显比离心收缩时更偏向外侧。在股四头肌收缩条件之间未观察到其他显著差异。本研究支持以下假设：髌骨不稳定很可能是由于各种解剖和生理因素导致伸肌机制无法将髌骨送入股骨沟，并且在正常膝关节中很少会发生髌骨脱位。
