Department of Orthopaedic Surgery, University Medical Center Rostock, Doberanerstrasse 142, 18057 Rostock, Germany.
Am J Sports Med. 2013 Jul;41(7):1621-8. doi: 10.1177/0363546513488869. Epub 2013 Jun 3.
Until now, no study has been published about the electromyographic changes in the extensor apparatus after the Green procedure for proximal realignment in young patients with recurrent patellar dislocations. This electromyographic study was performed to analyze imbalances between the vastus medialis and vastus lateralis muscles after different patellar realignment procedures.
Surgical proximal realignment leads to electromyographic changes in the extensor apparatus of the knee and to imbalances between the vastus medialis and vastus lateralis muscles.
Cohort study; Level of evidence, 3.
A total of 28 knees of 25 patients, with a mean age of 15 years, were treated operatively for recurrent patellar dislocations. The mean follow-up was 6.3 years. Depending on the type of surgical intervention, the patients were assigned to 3 different groups: the patients of group 1 underwent only the Green vastus medialis obliquus (VMO) advancement, group 2 was treated with a combination of the Green proximal and the Roux-Goldthwait distal realignment, and group 3 was treated with a combination of the Green proximal realignment and an additional tubercle transfer. All patients underwent clinical, radiological, and electromyographic examinations. The muscle activities of a healthy control group without patellar dislocations were used for comparison.
A combination of the Green procedure and tubercle transfer led to significantly better clinical results and a lower number of redislocations (P < .05) compared with patients who underwent only the Green proximal realignment. While ascending or descending stairs, the ratio between the electromyographic activities of the vastus medialis and vastus lateralis muscles in groups 1 and 2 was significantly smaller compared with the control group (P < .02). Only the electromyograms of group 3 revealed a balanced extensor apparatus during loading with comparable activities of the vastus medialis and vastus lateralis muscles and no significant difference to the control group (P = .37).
Our electromyographic investigations showed the importance of the vastus medialis in the pathogenesis of malalignment of the extensor mechanism. The Green VMO advancement without tibial tubercle transfer is not able to balance the activities of the vastus medialis and vastus lateralis muscles and cannot be recommended for further use.
迄今为止，尚无研究报道青少年复发性髌骨脱位患者行近端重排的 Green 手术后伸肌装置的肌电图变化。进行这项肌电图研究是为了分析不同髌骨重排术后股四头肌内侧与外侧之间的不平衡。
手术近端重排会导致膝关节伸肌装置的肌电图变化，并导致股四头肌内侧与外侧之间的不平衡。
队列研究；证据水平，3 级。
共对 25 例患者的 28 个膝关节进行手术治疗，平均年龄为 15 岁，均为复发性髌骨脱位。平均随访时间为 6.3 年。根据手术干预类型，患者分为 3 个不同组：组 1 仅行 Green 股四头肌内侧斜肌（VMO）推进术，组 2 行 Green 近端重排和 Roux-Goldthwait 远端重排联合治疗，组 3 行 Green 近端重排和附加结节转移联合治疗。所有患者均接受临床、影像学和肌电图检查。并使用无髌骨脱位的健康对照组的肌肉活动进行比较。
与仅行 Green 近端重排的患者相比，Green 手术联合结节转移可显著改善临床结果和降低再脱位率（P <.05）。在上下楼梯时，组 1 和组 2 的股四头肌内侧与外侧肌肉的肌电图活动之间的比率明显小于对照组（P <.02）。只有组 3 的肌电图显示在负荷下伸肌装置平衡，股四头肌内侧与外侧肌肉的活动相似，与对照组无显著差异（P =.37）。
我们的肌电图研究表明股四头肌内侧在伸肌机制对线不良的发病机制中起重要作用。Green VMO 推进术而不进行胫骨结节转移无法平衡股四头肌内侧与外侧肌肉的活动，不能再推荐使用。
