Walker C, Cassar-Pullicino V N, Vaisha R, McCall I W
Department of Diagnostic Imaging, Robert Jones and Agnes Hunt Hospital, Oswestry, Shropshire, UK.
Br J Radiol. 1993 Sep;66(789):755-61. doi: 10.1259/0007-1285-66-789-755.
In the quest for treatable causes of anterior knee pain, plain film skyline views of the patello-femoral joint are requested, often in 30 degrees, 60 degrees and 90 degrees of flexion, to assess the functional relationships of the joint. Patello-femoral malalignment predisposes to recurrent subluxation and dislocation, articular cartilage damage and premature degenerative change. The aim of this study is to evaluate critically, by comparative assessment, the information provided by skyline views and axial computed arthro-tomography (CTA). Measurements of the patello-femoral angle (assesses patellar tilt), the congruence angle (assesses patellar lateralization) and the trochlear depth were made on Merchant's skyline views and on axial CTA on each of 50 symptomatic knees. Results are presented in graphic form with visual examples indicating a poor correlation between the two imaging methods. We conclude that skyline views are inaccurate and unsuitable primarily because they cannot be obtained in less than 30 degrees of flexion. We suggest that skyline views have no role to play in screening for maltracking as even florid examples must be missed, and would strongly urge that no surgery be performed on their basis alone as this would result in inappropriate operations. Although computed tomography is the preferred mode of assessing patello-femoral geometry, difficulties are still encountered and the ways of circumventing them are discussed.
在探寻可治疗的前膝痛病因时，通常会要求拍摄髌股关节的普通X线天际线视图，通常在30度、60度和90度屈曲位，以评估关节的功能关系。髌股关节排列不齐易导致复发性半脱位和脱位、关节软骨损伤以及过早的退行性改变。本研究的目的是通过对比评估，严格评价天际线视图和轴向计算机关节断层扫描（CTA）所提供的信息。对50例有症状膝关节的每一例，在Merchant天际线视图和轴向CTA上测量髌股角（评估髌骨倾斜）、适合角（评估髌骨外侧移位）和滑车深度。结果以图表形式呈现，并配有视觉示例，表明两种成像方法之间相关性较差。我们得出结论，天际线视图不准确且不合适，主要是因为它们不能在小于30度屈曲位获得。我们认为天际线视图在筛查轨迹不良方面没有作用，因为即使是明显的病例也可能被漏诊，并且强烈敦促不要仅基于天际线视图进行手术，因为这会导致不恰当的手术。尽管计算机断层扫描是评估髌股几何形状的首选方式，但仍会遇到困难，本文将讨论规避这些困难的方法。
