Donell Simon T, Joseph George, Hing Caroline B, Marshall Tom J
Department of Trauma and Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK.
Knee. 2006 Aug;13(4):266-73. doi: 10.1016/j.knee.2006.01.004. Epub 2006 Apr 24.
Instability of the patella occurs when it fails to track fully in the femoral groove during knee movement. The groove begins at the metaphysis of the distal femur and extends on its anterior surface inferiorly to the femoral notch. It is normally present at birth and the cartilaginous shape is similar to that of the adult. An abnormal trochlea may be shallow. In extreme cases it may be dome-shaped, where it is associated with recurrent subluxation or dislocation of the patella. In these cases it is logical to consider fashioning a groove as part of a realignment procedure. This study reports the operative technique and early clinical and radiological results of a consecutive case series of the first 15 patients (17 knees) who underwent a deepening trochleoplasty for severe dysplasia developed from that described by Dejour. The follow-up was for a minimum of 1 year (average 3 years, range 1 to 9 years). The boss height was reduced from an average of 7.5 mm (range 6 to 11 mm) to 0.7 mm (range -1 to 3 mm). Tracking became normal in 11 knees and had a slight J-shaped in six. Seven knees had mild residual apprehension. Seven patients were very satisfied, six were satisfied, and two were disappointed. The Kujala score improved from an average of 48 (range 13 to 75) to 75 (range 51 to 98) out of 100 (p<0.05). Three patients returned to full sports. Eight patients required further operations apart from the removal of metallic screws in 10 knees. Five of these were arthroscopic arthrolysis for stiffness at about 6 weeks post-operatively. Trochleoplasty for severe dysplasia of the femoral sulcus is a developing procedure. It requires careful attention to detail. For a rare condition the early results have been satisfactory with an acceptable level of complications.
髌骨不稳定是指在膝关节运动过程中，髌骨未能完全在股骨沟内滑动。股骨沟始于股骨远端干骺端，沿其前表面向下延伸至股骨切迹。它在出生时就已存在，软骨形状与成人相似。异常的滑车沟可能较浅。在极端情况下，它可能呈圆顶状，与髌骨反复半脱位或脱位有关。在这些情况下，将股骨沟加深作为矫正手术的一部分是合理的。本研究报告了连续15例患者（17个膝关节）接受针对Dejour所描述的严重发育不良进行的滑车沟加深成形术的手术技术、早期临床和放射学结果。随访时间至少为1年（平均3年，范围1至9年）。骨嵴高度从平均7.5毫米（范围6至11毫米）降至0.7毫米（范围-1至3毫米）。11个膝关节的滑动恢复正常，6个呈轻度J形。7个膝关节有轻度残留恐惧。7例患者非常满意，6例满意，2例失望。Kujala评分从平均48分（范围13至75分）提高到75分（范围51至98分）（满分100分，p<0.05）。3例患者恢复了全面运动。除了10个膝关节取出金属螺钉外，8例患者还需要进一步手术。其中5例在术后约6周因僵硬接受关节镜下关节松解术。针对股骨沟严重发育不良的滑车沟加深成形术是一种正在发展的手术。它需要对细节予以仔细关注。对于一种罕见疾病，早期结果令人满意，并发症水平可接受。
