Marcacci M, Zaffagnini S, Iacono F, Visani A, Petitto A, Neri N P
Laboratorio di Biomeccanica, Istituti Ortopedici Rizzoli, Bologna, Italy.
Knee Surg Sports Traumatol Arthrosc. 1995;3(3):163-6. doi: 10.1007/BF01565476.
The authors compare the clinical and radiographic outcome in patients with comparable bilateral recurrent patellar dislocation treated surgically on only one side, to clarify the appropriateness of the surgical indication. Sixteen patients were evaluated at an average follow-up of 30 years (20-45); all had been treated by the Roux technique. The results on both the operated and the unoperated knee were evaluated; the Crosby and Insall schedule was used for the clinical evaluation. Anteroposterior, lateral, and Merchant's view X-rays were examined for osteoarthritis and to measure the height of the patella. The congruence angle and the distance between anterior tibial tuberosity and trochlear groove (ATT-TG) were measured by computed tomography. The results in the operated knees were: 3 excellent, 9 good, 1 fair, and 3 worse; results in the nonoperated knees were 6 excellent, 8 good, 1 fair, and 1 worse. In the operated knees arthritis was grossly marked in 8, marked in 3, moderate in 1, and light in 4; in the nonoperated ones it was grossly marked in 8, moderate in 3, and light in 5. The congruence angle was normal in 10, medially displaced in 3, and laterally displaced in 3 cases on the operated side; on the nonoperated side it was normal in 7 cases and lateralized in the remaining 9. The ATT-TG in the operated knees was negative in 9 cases, normal in 1, and positive in 6; on the non-operated side it was positive or normal. In 7 operated cases a low patella was documented. The Roux technique yields positive results in the correction of recurrent dislocation. No clinical or radiographic differences were found between surgically and conservatively treated knees. The clinical results are generally not comparable with the radiographic features or with severity of degenerative modifications presented at long-term follow-up. The absence of a difference is due basically to the complete lack of adaptation of the surgical procedure to the variable pathogenesis of this disorder.
作者比较了仅一侧接受手术治疗的双侧复发性髌骨脱位患者的临床和影像学结果，以阐明手术指征的合理性。对16例患者进行了平均30年（20 - 45年）的随访评估；所有患者均采用Roux技术治疗。对手术侧和未手术侧膝关节的结果进行了评估；临床评估采用Crosby和Insall评分表。拍摄前后位、侧位和Merchant位X线片以检查骨关节炎情况并测量髌骨高度。通过计算机断层扫描测量重合角以及胫骨结节与滑车沟之间的距离（ATT - TG）。手术侧膝关节的结果为：3例优，9例良，1例可，3例差；未手术侧膝关节的结果为：6例优，8例良，1例可，1例差。手术侧膝关节中，严重关节炎8例，明显关节炎3例，中度关节炎1例，轻度关节炎4例；未手术侧中，严重关节炎8例，中度关节炎3例，轻度关节炎5例。手术侧重合角正常10例，内侧移位3例，外侧移位3例；未手术侧7例正常，其余9例为外侧移位。手术侧膝关节的ATT - TG为阴性9例，正常1例，阳性6例；未手术侧为阳性或正常。7例手术病例记录有低位髌骨。Roux技术在复发性脱位的矫正中取得了积极效果。手术治疗和保守治疗的膝关节之间未发现临床或影像学差异。临床结果通常与影像学特征或长期随访中出现的退行性改变严重程度不可比。差异的不存在基本上是由于手术操作完全没有适应这种疾病可变的发病机制。
