股骨滑车发育不良的病因及治疗:是先天基因还是后天髌骨应力刺激

Etiology and treatment of femoral trochlear dysplasia:congenital genetic determination or stress stimulation of patella

背景:髌股关节不稳是骨科常见的问题,其病因是多种多样的,比如股骨滑车发育不良、高位髌骨、膝外翻、过大的股骨和胫骨扭转畸形、过大的胫骨结节-滑车沟距离、内侧髌股韧带损伤等,其中滑车发育不良被视为最重要的危险因素。目的:对滑车发育不良的病因、影像学评估、带来的临床问题以及滑车成形术的研究进展进行综述。方法:以“trochlear dysplasia,trochleoplasty”为英文检索词,以“滑车发育不良,滑车成形术”为中文检索词,第一作者在PubMed数据库、中国知网数据库、万方数据库进行检索,检索时限至2020年7月,排除重复及与研究目的无关的文章,最终纳入56篇文章进行综述。结果与结论:①有关滑车发育不良的病因主要有2个学说,即先天性基因决定与后天髌骨的应力刺激,一系列从动物实验到人体研究表明髌骨的应力刺激对滑车发育至关重要;②滑车发育不良的影像学评估,包括膝关节纯侧位X射线片以及轴位CT/MRI,可以达到量化评估,滑车发育不良的分型从经典的Dejour分型,发展到更为可靠的OBC分型;③从生物力学到临床观察都表明滑车发育不良是髌股关节不稳的最主要危险因素,而且滑车发育不良与软骨磨损和前交叉韧带损伤也有相关性;④滑车成形术是最直接的改变滑车异常形态的方式,在把握好适应证与禁忌证的前提下,滑车成形术可以取得满意的临床效果。

BACKGROUND:Patellofemoral instability is the common problem in orthopedics,and the etiology can be multifactorial,such as trochlear dysplasia,patella alta,increased torsion of femur and tibia,elevated tibial tuberosity-trochlea groove distance,and the injury of media patellofemoral ligament.Among them,trochlear dysplasia is regarded as the most important risk factor.OBJECTIVE:To review the etiology,image evaluation,clinical problem of trochlear dysplasia and trochleoplasty.METHODS:The“trochlear dysplasia,trochleoplasty”were used as Chinese and English search terms.The first author searched English database such as PubMed and Chinese databases such as CNKI and Wanfang,and the retrieval deadline was July 2020.Repetitive and irrelevant articles were excluded,and final 56 articles were included for review.RESULTS AND CONCLUSION:(1)There are two main theories about the etiology of trochlear dysplasia;that is,congenital genetic determination and the stress stimulation of patella.A series of studies from animal experiment to human studies have shown that the stress stimulation is essential to trochlear development.(2)Imagine evaluation of trochlear dysplasia includes the pure lateral radiographs of knee joint and axial CT/MRI which can achieve quantitative evaluation.The classification of trochlear dysplasia has evolved from the classical Dejour classification to the more reliable OBC classification.(3)A series of studies from biomechanics to clinic have supported that trochlear dysplasia is the most important risk factor for patellofemoral instability,and trochlear dysplasia is also associated with cartilage wear and anterior cruciate injury.(4)Trochleoplasty is the most direct way to change the abnormal shape of trochlea.Under the premise of grasping the indications and contraindications,trochleoplasty can achieve satisfactory clinical results.