Filho Ricardo Bastos, Monteiro Alberto, Andrade Renato, Michael M J S Fredrick, Sevivas Nuno, Pereira Bruno, Sarmento André, Espregueira-Mendes João
Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal.
Dom Henrique Research Centre, Porto, Portugal.
Arthrosc Tech. 2017 Nov 27;6(6):e2277-e2282. doi: 10.1016/j.eats.2017.08.037. eCollection 2017 Dec.
Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity.
髌股关节功能障碍，无论是由于髌股关节排列不齐还是髌骨不稳定，都是一种复杂且使人衰弱的病症，会显著降低膝关节功能。保守治疗可能会产生显著的临床效果；然而，当发现形态异常时，应采用手术方法。因此，科学文献中描述了几种旨在纠正潜在伸肌机制排列不齐的手术方法。尽管如此，并发症的发生率仍高于预期。所描述的技术基于如Elmslie-Trillat技术中所述的将胫骨结节向内移位的原则。然而，在垂直切口之前先进行一条曲线形的水平切口，这样会掀起一块厚骨块，当骨块向内移动时可形成一个沟槽。水平沟槽为骨块提供稳定性，而骨块更厚的尺寸以及远端附着的保留显著增强了截骨愈合。因此，可以实现充分的疼痛缓解和稳定性，且术后发病率极低。本手术记录的目的是描述对Elmslie-Trillat技术的一种改良，以治疗髌股关节功能障碍，实现更高的骨稳定性并降低术后发病率。
