Institute of Biomedical Engineering, National Yang Ming University, No. 155, Sec 2, Li-Nung Street, Taipei 112, Taiwan.
J Orthop Surg Res. 2008 Feb 12;3:5. doi: 10.1186/1749-799X-3-5.
The various measurements of patellar tilting failed to isolate patellar tilting from the confounding effect of its neighboring bone rotation (femoral and tibial rotation) in people sustaining patellofemoral pain (PFPS). Abnormal motions of the tibia and the femur are believed to have an effect on patellofemoral mechanics and therefore PFPS. The current work is to explore the various effects of neighboring bone rotation on the various measurements of patellar tilting, through an axial computed tomography study, to help selecting a better parameter for patella tilting and implement a rationale for the necessary intervention at controlling the limb alignment in the therapeutic regime of PFPS.
Forty seven patients (90 knees), comprising of 34 females and 11 males, participated in this study. Forty five knees, from randomly selected sides of bilaterally painful knees and the painful knees of unilaterally painful knees, were enrolled into the study. From the axial CT images in the subject knees in extension with quadriceps relaxed, the measurements of femoral rotation, tibial rotation, femoral rotation relative to tibia, and 3 parameters for patella tilting were obtained and analyzed to explore the relationship between the different measurements of patella tilt angle and the measurements of its neighboring bone rotation (femoral, tibial rotation, and femoral rotation relative to tibia).
The effect of femoral, tibial rotation, and femoral rotation relative to tibia on patella tilting varied with the difference in the way of measuring the patella tilt angle. Patella tilt angle of Grelsamer increased with increase in femoral rotation, and tibial rotation. Patella tilt angle of Sasaki was stationary with change in femoral rotation, tibial rotation, or femoral rotation relative to tibia. While, modified patella tilt angle of Fulkerson decreased with increase in femoral rotation, tibial rotation, or femoral rotation relative to tibia.
The current study has demonstrated various effects of regional bony alignment on the different measurements of the patellar tilt. And the influence of bony malalignment on the patellar tilt might draw a clinical implication that patellar malalignment can not be treated, separately, independent of the related limb alignment. This clinical implication has to be verified by further works, with a comprehensive evaluation of the various treatments of patellar malalignment.
在患有髌股关节疼痛（PFPS）的人群中，各种髌股倾斜测量方法均未能将髌股倾斜与相邻骨骼旋转（股骨和胫骨旋转）的混杂效应分离开来。人们相信，胫骨和股骨的异常运动对髌股力学有影响，因此也会影响 PFPS。目前的工作是通过轴向计算机断层扫描研究来探索相邻骨骼旋转对髌股倾斜各种测量方法的各种影响，以帮助选择更好的髌股倾斜参数，并为控制肢体对线的必要干预措施提供合理的依据，从而作为 PFPS 治疗方案的一部分。
47 名患者（90 个膝关节），包括 34 名女性和 11 名男性，参与了这项研究。45 个膝关节，来自双侧疼痛膝关节和单侧疼痛膝关节的随机选择侧，被纳入研究。从膝关节在股四头肌放松时的伸展轴向 CT 图像中，获得并分析了股骨旋转、胫骨旋转、股骨相对于胫骨的旋转以及 3 个髌股倾斜参数的测量值，以探讨不同髌股倾斜角度的测量值与相邻骨骼旋转（股骨、胫骨旋转和股骨相对于胫骨的旋转）的测量值之间的关系。
股骨、胫骨旋转和股骨相对于胫骨的旋转对髌股倾斜的影响因测量髌股倾斜角度的方式不同而有所不同。Grelsamer 髌股倾斜角随股骨旋转和胫骨旋转的增加而增加。Sasaki 髌股倾斜角在股骨旋转、胫骨旋转或股骨相对于胫骨的旋转变化时保持不变。而 Fulkerson 改良髌股倾斜角随股骨旋转、胫骨旋转或股骨相对于胫骨的旋转增加而减小。
目前的研究表明，局部骨骼对线对髌股倾斜的不同测量值有不同的影响。骨骼对线不良对髌股倾斜的影响可能暗示髌股对线不良不能单独、独立于相关的肢体对线来治疗。这一临床意义需要通过进一步的工作来验证，需要对髌股对线不良的各种治疗方法进行全面评估。
