滑车成形术：适应症与技术
Trochleoplasty: Indications and Technique.
作者信息
Nolan John E, Schottel Patrick C, Endres Nathan K
机构信息
Department of Orthopaedics and Rehabilitation, University of Vermont Medical Center, 95 Carrigan Drive, Robert T. Stafford Hall, 4th Floor, Burlington, VT, 05405, USA.
Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, 192 Tilley Drive, South Burlington, VT, 05403, USA.
出版信息
Curr Rev Musculoskelet Med. 2018 Jun;11(2):231-240. doi: 10.1007/s12178-018-9478-z.
PURPOSE OF REVIEW
Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures.
RECENT FINDINGS
Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.
综述目的
滑车发育不良是已明确的髌骨不稳定危险因素。滑车成形术已成为治疗髌骨不稳定的手术方法之一，但其作用尚不清楚。多种滑车成形术已出现。本综述的目的是明确滑车成形术的适应证，概述常见滑车成形术的技术步骤，并报告这些手术已发表的结果及潜在并发症。
最新发现
伴有严重滑车发育不良的髌骨不稳定是滑车成形术的主要适应证。已出现三种类型的滑车成形术：（1）外侧关节面抬高；（2）沟加深；（3）后倾楔形截骨。沟加深和后倾楔形截骨滑车成形术是最常用的。滑车成形术是治疗严重滑车发育不良患者髌骨不稳定的一种手术选择。针对Dejour B型和D型发育不良滑车的沟加深和后倾楔形截骨滑车成形术研究最多，已有短期和中期结果报道。缺乏长期结果，需要进行比较研究。
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