Briard J L, Hungerford D S
Centre Medico-Chirurgical Du Cedre, Bois-Guillaume, France.
J Arthroplasty. 1989;4 Suppl:S87-97. doi: 10.1016/s0883-5403(89)80013-0.
Patellofemoral instability following total knee arthroplasty remains one of the major complications requiring operative intervention. In spite of recent advances in technique and instrumentation, the rate of this complication remains disturbingly high. A comprehensive analysis of cause reveals malalignment of any of the components to be potentially responsible, particularly valgus or internal rotation malalignment of either femoral or tibial component, as well as lateral displacement of the patellar component. Underresection of the patella or oversizing the femoral component may also contribute to excessive lateral retinacular tightness. When confronted with patellofemoral instability, the surgeon must first look for and correct the cause. Component malalignment requires component revision. Extensor mechanism imbalance requires either proximal or distal realignment. Lateral release alone invites recurrence of the problem.
全膝关节置换术后髌股关节不稳仍然是需要手术干预的主要并发症之一。尽管近年来技术和器械有了进步，但这种并发症的发生率仍然高得令人不安。对病因的综合分析表明，任何一个组件的排列不齐都可能是原因，特别是股骨或胫骨组件的外翻或内旋排列不齐，以及髌骨组件的侧向移位。髌骨切除不足或股骨组件尺寸过大也可能导致外侧支持带过度紧张。当面对髌股关节不稳时，外科医生必须首先寻找并纠正病因。组件排列不齐需要进行组件翻修。伸肌机制失衡需要近端或远端重新排列。单纯的外侧松解会导致问题复发。
