Morscher E
Arch Orthop Trauma Surg (1978). 1978 Aug 30;92(2-3):139-47. doi: 10.1007/BF00397950.
There are many factors involved in the aetiology of chondromalacia of the patella. If possible, the appropriate operative procedure should be chosen for each patient, hence attempting to eliminate the cause of softening of the cartilage. Increased pressure over the lateral facet, with or without reduced pressure over the medial facet of the patella, resulting from lateral positioning or tilting of the patella, the Wiberg/Baumgartl-types III and IV, and the "Hunter's Hat" form are important causes. With reduced pressure, the cartilage is inadequately stressed and consequently receives insufficient nourishment. As the medial facet is particularly thick and has little contact with the femoral condyle, nutritional disturbance is almost a normal occurrence. Longitudinal osteotomy of the patella has been found to improve the contact of the medial surface of the patella with the femoral condylar groove. The analgesic effect of this surgical procedure may derive from the resultant reduction in subchondral interstitial pressure, presuming that the pain in chondromalacia patellae, like that of osteoarthritis, is a manifestation of raised intramedullary pressure. To ensure an improvement in patellar tracking the osteotomy is combined with a lateral capsular release.
髌骨软化症的病因涉及多种因素。若有可能，应为每位患者选择合适的手术方式，从而尝试消除软骨软化的病因。髌骨外侧移位或倾斜导致外侧关节面压力增加，无论内侧关节面压力是否降低，以及Wiberg/Baumgartl III型和IV型及“亨特帽”形态，都是重要病因。压力降低时，软骨所受应力不足，因而营养供应不充分。由于内侧关节面特别厚且与股骨髁接触少，营养障碍几乎是常态。已发现髌骨纵行截骨术可改善髌骨内侧表面与股骨髁间沟的接触。该手术的镇痛效果可能源于由此导致的软骨下间隙压力降低，假定髌骨软化症的疼痛与骨关节炎的疼痛一样，是髓内压力升高的表现。为确保髌骨轨迹改善，截骨术需联合外侧关节囊松解术。
