Yan Peng'an, Lu Fan, Cai Yifan, Yan Zhenxing, Wei Yuqiao, Sun Chongxiao, Geng Bin, Xia Yayi
Department of Orthopaedics , the Second Hospital of Lanzhou University, Lanzhou Gansu, 730030, P. R. China.
Orthopaedic Clinical Research Center of Gansu Province, Lanzhou Gansu, 730030, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2024 Oct 15;38(10):1276-1282. doi: 10.7507/1002-1892.202405051.
To review research progress on femoral attachment positioning during medial patellofemoral ligament (MPFL) reconstruction, so as to provide a reference for accurate positioning in clinic.
The literature at home and abroad on femoral attachment positioning during MPFL reconstruction was extensively reviewed and summarized.
MPFL is the main ligament that restricts patellar outward migration, so MPFL reconstruction is the main treatment for patellar dislocation, but the accuracy of intraoperative femoral attachment positioning will significantly affect the effectiveness. At present, there are three main methods for femoral attachment positioning in MPFL reconstruction, including imaging positioning, bony landmark positioning, and new technology. Among them, the main imaging positioning method is the "Schöttle point" method, but it has high requirements for fluoroscopic positioning, and can only be accurately positioned under standard lateral fluoroscopy of the femur. The bony landmark positioning method mainly locates the femoral attachment by touching or dissecting the bony landmarks such as adductor tubercles and medial epicondyle of femur, but its disadvantages are that the positioning is not accurate enough, the intraoperative visual field exposure requirements are high, and a large incision is required. In order to avoid the problem that the simple bony landmark positioning method, in recent years, the combination of bony landmarks combined with arthroscopy, three-dimensional (3D) printing technology, and robot-assisted positioning methods have begun to be used in clinical practice. New technology localization methods have shown good results by preparing guides before operation, planning positioning paths in advance, or directly using robots to assist positioning during operation.
The accurate positioning of the femoral attachment in MPFL reconstruction is crucial, and the method of accurate and rapid intraoperative determination needs to be further improved and optimized. In the future, it is expected that the combination of computer image recognition correction technology and intraoperative position assistance will solve this problem.
综述内侧髌股韧带（MPFL）重建术中股骨附着点定位的研究进展，为临床精确化定位提供参考。
广泛查阅并总结国内外关于MPFL重建术中股骨附着点定位的文献。
MPFL是限制髌骨向外移位的主要韧带，因此MPFL重建是治疗髌骨脱位的主要方法，但术中股骨附着点定位的准确性将显著影响治疗效果。目前，MPFL重建术中股骨附着点定位主要有三种方法，包括影像学定位、骨性标志定位和新技术。其中，主要的影像学定位方法是“Schöttle点”法，但对透视定位要求较高，且仅能在标准的股骨侧位透视下准确定位。骨性标志定位法主要通过触摸或解剖股骨内收肌结节、股骨内侧髁等骨性标志来定位股骨附着点，但其缺点是定位不够准确，术中视野暴露要求高，且需要较大切口。为避免单纯骨性标志定位法存在的问题，近年来，骨性标志结合关节镜、三维（3D）打印技术及机器人辅助定位方法已开始应用于临床实践。新技术定位方法通过术前制备导板、预先规划定位路径或术中直接使用机器人辅助定位等方式取得了较好效果。
MPFL重建术中股骨附着点的精确性定位至关重要，术中准确快速确定定位的方法有待进一步改进和优化。未来，期望计算机图像识别校正技术与术中位置辅助相结合能解决这一问题。
