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中华关节外科杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 398 -404. doi: 10.3877/cma.j.issn.1674-134X.2024.03.014

综述

关于胫骨高位截骨术后髌股关节变化的研究进展
蒋政1, 郑楠1, 毛彦杰1, 何阿祥1, 林蔚铭1, 郭瀚1, 刘语嫣1, 臧慧1, 王聪1, 刘万军1,()   
  1. 1. 201306 上海交通大学医学院附属第六人民医院
  • 收稿日期:2023-11-07 出版日期:2024-06-01
  • 通信作者: 刘万军

Research progress on changes in patellofemoral joint after high tibial osteotomy

Zheng Jiang1, Nan Zheng1, Yanjie Mao1, Axiang He1, Weiming Lin1, Han Guo1, Yuyan Liu1, Hui Zang1, Cong Wang1, Wanjun Liu1,()   

  1. 1. Shanghai sixth people's hospital affiliated to Shanghai Jiaotong University school of medicine, Shanghai 201306, China
  • Received:2023-11-07 Published:2024-06-01
  • Corresponding author: Wanjun Liu
引用本文:

蒋政, 郑楠, 毛彦杰, 何阿祥, 林蔚铭, 郭瀚, 刘语嫣, 臧慧, 王聪, 刘万军. 关于胫骨高位截骨术后髌股关节变化的研究进展[J]. 中华关节外科杂志(电子版), 2024, 18(03): 398-404.

Zheng Jiang, Nan Zheng, Yanjie Mao, Axiang He, Weiming Lin, Han Guo, Yuyan Liu, Hui Zang, Cong Wang, Wanjun Liu. Research progress on changes in patellofemoral joint after high tibial osteotomy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(03): 398-404.

胫骨高位截骨术是治疗早期膝关节骨关节炎的一种选择。然而,在术后的长期随访中,人们发现术侧膝关节的髌骨位置会发生变化,导致其在日常运动中活动轨迹异常。多项研究表明,这种异常运动很可能引起髌股关节的退行性变。为了解决这种变化,临床上已经推出了多种改良术式。本文旨在阐明术后髌股关节在临床表现、影像学和生物力学方面的变化,探讨这些变化对术后功能的影响,总结改良方法,并为后续临床研究提供参考。

High tibial osteotomy (HTO) is an option for the treatment of early stage arthritis of the knee. However, the patella position in HTO side altered during long term postoperative follow-up period, resulting in abnormal movement in daily activities which is highly relevant to the degeneration of patellofemoral joint revealed in several studies.Therefore, a variety of improved surgical methods have been introduced in clinics to solve this problem. This article aimed to clarify the changes in clinical medicine, imaging and biomechanics of the patellofemoral joint after surgery, explore the impact of these changes on postoperative life, summarize the improvement methods, and provide references for the subsequent clinical researches.

图1 在膝关节负重屈曲侧位片上测量髌骨高度。图A示ISI (Insall-Salvati 指数)=a/b;图B示Caton de Champs 指数=c/d;图C示BPI (Blackburn Peel指数)=e/f
Figure 1 Patella height measured onlateral radiograph of the weight-bearing flexed knee. A shows ISI=a/b;B shows Caton de Champs index=c/d;C shows BPI=e/f
图2 在膝关节轴位片上测量髌骨位置方法。图A为外侧髌股关节角;图B为髌骨外侧移位(髌骨外侧极与股骨滑车外侧顶点分别至股骨后髁连线的垂线间距离);图C为外侧髌骨倾斜角(后髁轴位片投影点连线为参考线);图D为髌骨倾斜角(后髁轴位片投影点连线为参考线)
Figure 2 The method for measuring the patellar position on the axial radiograph of the knee joint. A is lateral patellofemoral joint angle; B is lateral displacement of the patella (the distance between the vertical lines of lateral pole of the patella and the lateral apex of the femoral pulley to the line connecting posterior condyles of the femur.); C is lateral patellar inclination angle (using the line connecting the projection points of the posterior condyles on the axial radiograph as reference line); D is patellar inclination angle (using the line connecting the projection points of posterior condyles on the axial radiograph as reference line)
图3 髌骨面与滑车平面平均模型的位置关系热图 注:14名患者在术前及术后6个月,做上楼梯运动的运动周期中某同一时刻在双平面正交荧光透视成像系统下所计算分析得出(以髌骨面相对滑车面靠近方向为正,单位:mm)
Figure 3 Heat map of the relative position of the average model of the patellar surface and the trochlear plane Note: This heat map was calculated and analyzed under the bi-plane orthogonal fluoroscopy imaging system at the same stance during the stair-climbing motion cycle of 14 patients before surgery and six months after surgery. (the direction in which the patellar surface is closer to the trochlear surface is positive, unit: mm)
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