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社论评论:内侧髌股韧带重建中正确的股骨隧道位置需要最佳的影像学技术。

Editorial Commentary: Proper Femoral Tunnel Placement for Medial Patellofemoral Ligament Reconstruction Requires Optimal Radiographic Technique.

出版信息

Arthroscopy. 2024 Jun;40(6):1867-1869. doi: 10.1016/j.arthro.2023.12.024. Epub 2024 Jan 12.

Abstract

Femoral tunnel malposition has been shown to be a risk factor for medial patellofemoral ligament reconstruction failure. Palpation of the "saddle point" between the adductor tubercle and medial epicondyle can be an effective strategy; however, compared to using fluoroscopy, tunnel placement using palpation alone may result in significantly more frequent malposition. Accordingly, use of radiographic landmarks has gained in popularity. However, the technique is not without its pitfalls. The first issue lies with obtaining an adequate x-ray. Deviation from a true lateral x-ray by as little as 5° can result in significant tunnel malposition. Including sufficient visible femoral shaft is also required; a minimum requirement is 4 cm. The literature widely varies as to the anatomic, fluoroscopic position. Schottle's point (1.3 mm anterior to the posterior cortical extension line) is the most well studied.

摘要

股骨髓道位置不当已被证实是内侧髌股韧带重建失败的一个风险因素。在收肌结节和内上髁之间触诊“鞍点”可以是一种有效的策略;然而,与使用透视相比,单独使用触诊进行隧道放置可能会导致更频繁的位置不当。因此,放射学标志的使用越来越受欢迎。然而,该技术并非没有缺陷。第一个问题在于获得合适的 X 光片。与真正的侧位 X 光片偏差 5°以内,就会导致明显的隧道位置不当。还需要包括足够可见的股骨干,最小要求为 4 厘米。文献对解剖学、透视位置的描述差异很大。Schottle 点(后皮质延伸线前 1.3 毫米)是研究最多的点。

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