Servien E, Ait Si Selmi T, Neyret P
Centre Livet, Service de Chirurgie Orthopédique, Hôpital de la Croix-Rousse, 8, rue des Margnolles, 69330 Caluire et Cuire.
Rev Chir Orthop Reparatrice Appar Mot. 2003 Nov;89(7):605-12.
The purpose of this work was to study the morphology of the patella in search of dysplasia typical of objective patellar dislocation.
One hundred forty patients (190 knees), 80 women and 60 men, who underwent surgery between 1988 and 1999 were included in this study. Mean age was 22.6 years (range 13-47). Patellar morphology was analyzed on the preoperative lateral x-rays (n=190) taken at 30 degrees flexion. The apex of the patella was measured as well as the length of the patellar tendon. The width of the patella was measured on the computed tomography scan (n=158). For 64 knees, magnetic resonance images of the patella were available on which the length and width of the patella, the articular surface, and the patellar tendon were measured. Ninety contralateral knees were symptom free and x-rays were available for 67.
According to the Grelsamer classification, 80% of the patellae presented a normal apex. The length of the patellar apex was significantly shorter when the patellar ligament was longer. Using the Wiberg classification, men had more dysplasic patellae (grade C) (p=0.007). There was also a correlation between the Wiberg classification and the Maldague classification. The length of the medial border of the patella and the patellar angle were 2 factors directly related to the Wiberg classification. Mean width of the patella was 39.1 mm (computed tomography measurements). The mean length of the patellar tendon was 53.8 on the magnetic resonance images with a mean articular surface measuring 30.8 mm, a mean patellar length measuring 40.6 mm, and a mean width measuring 38.7 mm. There was no correlation between trochlear dysplasia and patellar morphology.
There is little data in the literature concerning patellar morphology since Wiberg's work in 1941. The hypothesis of patellar dysplasia rather than trochlear dyplasia, the principal factor involved in objective patellar dislocation, has not been explored extensively. The presence of a hypoplasic medial border, Wiberg grade C, or a short patellar apex suggests that a particular patellar morphotype would be involved in objective patellar dislocation.
本研究旨在研究髌骨形态，以寻找典型的客观髌骨脱位发育异常情况。
本研究纳入了1988年至1999年间接受手术的140例患者（190个膝关节），其中女性80例，男性60例。平均年龄为22.6岁（范围13 - 47岁）。在术前30度屈曲位拍摄的侧位X线片（n = 190）上分析髌骨形态。测量髌骨顶点以及髌腱长度。在计算机断层扫描（n = 158）上测量髌骨宽度。对于64个膝关节，可获得髌骨的磁共振图像，测量了髌骨的长度和宽度、关节面以及髌腱。90个对侧膝关节无症状，其中67个有X线片。
根据格雷尔萨默分类，80%的髌骨顶点正常。当髌韧带较长时，髌骨顶点长度明显较短。使用维伯格分类，男性有更多发育异常的髌骨（C级）（p = 0.007）。维伯格分类与马尔达格分类之间也存在相关性。髌骨内侧缘长度和髌骨角是与维伯格分类直接相关的两个因素。髌骨平均宽度为39.1mm（计算机断层扫描测量）。在磁共振图像上，髌腱平均长度为53.8mm，平均关节面为30.8mm，平均髌骨长度为40.6mm，平均宽度为38.7mm。滑车发育异常与髌骨形态之间无相关性。
自1941年维伯格的研究以来，关于髌骨形态的文献资料很少。髌骨发育异常而非滑车发育异常这一客观髌骨脱位的主要因素的假说尚未得到广泛探讨。内侧缘发育不全、维伯格C级或髌骨顶点短的存在表明，特定的髌骨形态类型可能与客观髌骨脱位有关。
