髌股关节排列异常

髌股关节排列异常柴卫兵马忠泰高淑能前膝痛是膝关节疼痛中最为常见的症状之一，其病因包括髌股关节排列异常，髌骨软骨软化症，骨关节病，滑膜病，髌周肌肉及肌腱劳损，脂肪垫肥大和损伤以及外伤后的骨软骨损伤等。其中髌股关节排列异常是在诊断上易于混淆和忽视、处理上...     

髌股关节排列异常的CT检查

对髌股关节进行ＣＴ测量,确定有无髌股排列异常。方法 对一组２０例４０侧膝关节进行ＣＴ检查,分别在股四头股收缩和松驰状况下扫描,对ＣＴ图像进行测量。结果４０膝中有１０膝为静力性骨外侧半脱位,另３０膝中有１６膝为动力性髌骨半脱位;４０膝中１１膝为性髌骨外倾,另有７膝为动力性髌骨外倾。     

基于磁共振图像构建髌股关节三维有限元模型

[目的]探讨基于活体髌股关节磁共振图像应用逆向工程准确构建髌股关节三维有限元模型的方法.[方法]采集1例健康青年男性志愿者膝关节磁共振图像,应用Mimics软件提取髌股关节轮廓曲线,再经AutoCAD软件及SolidWorks软件对曲面进行反求拟合、修整装配,生成了表面光滑的髌股关节骨软骨三维实体模型,并应用ABAQUS软件定义各部件材料力学属性、网格划分后,进行髌股关节应力分析.[结果]本研究成功建立了包括髌骨骨、软骨,股骨骨、软骨的三维有限元模型并进行应力分析,分析结果与既往研究方法结果相似.[结论]基于MRI数据可精确构建髌股关节三维实体模型,该模型可用于该关节的三维有限元应力分析,为深入对其进行生物力学研究提供技术支撑.     

髌股关节发育不良对髌骨脱位磁共振成像表现的影响

背景：当存在髌股关节发育不良时,髌骨脱位的损伤程度较轻,因此更加依赖影像学诊断。 目的：比较髌股关节发育不良患者和髌股关节发育正常患者髌骨脱位时磁共振成像（MRI）表现的异同。 方法：回顾性分析54例经临床证实的髌骨脱位患者的MRI影像学资料。髌股关节发育不良患者32例,髌股关节发育正常患者22例。记录患者MRI中髌骨内侧骨挫伤或撕脱骨折、髌骨关节面骨软骨骨折、股骨外侧髁外侧部骨挫伤、髌股内侧支持带撕裂等情况。 结果：髌股关节发育不良组的32例患者中,髌骨内缘骨折12例,内侧支持带损伤10例,髌骨软骨损伤7例,股骨外髁骨挫伤18例;髌股关节发育正常组的22例患者中,髌骨内缘骨折8例,内侧支持带损伤14例,髌骨软骨损伤14例,股骨外髁骨挫伤14例。两组在内侧支持带损伤和髌骨内缘骨折上有显著统计学差异（P＜0.05）。 结论：MRI可以较好地诊断髌骨脱位。当髌股关节发育不良时,内侧支持带损伤和髌骨内缘骨折的发生率降低。     

髌股关节准动态三维运动模型的构建及其应用

[目的]利用多角度静态核磁共振扫描图像重建在体髌股关节准动态三维运动模型,并以此动态模型计算屈伸膝过程中的髌骨运动轨迹、髌股关节旋转轴。[方法]选择1名健康成年男性,对其右膝关节分别在0°、30°、60°、90°、120°5个屈膝角度进行核磁共振扫描,将扫描结果以Dicom格式导入Mimics软件中,提取髌骨、股骨轮廓,重建五个屈膝角度的静态髌股关节三维模型,再将五个静态模型导入逆向工程软件Rapidform中进行同一坐标系的配准,利用三次样条插值算法,将离散静态模型配准为动态三维运动模型;并据此动态三维模型计算髌骨运动轨迹和髌股关节旋转轴。[结果]基于静态核磁共振图像可以快速构建准确而无辐射的髌股关节准动态三维运动模型,以此动态模型计算出的髌骨运动轨迹和髌股关节旋转轴与既往文献结果相一致。[结论]在屈膝过程中,髌骨随着屈膝角度的增加相对于股骨滑车不断俯屈,同时轻度的外倾和外旋,而髌股关节旋转轴波动在股骨通髁线附近。     

关节镜下髌周支持带平衡术治疗髌股关节对合异常

目的探讨采用关节镜下髌周支持带平衡术治疗髌股关节对合异常的临床疗效。方法自2007年9月~2011年9月,对53例(62膝)髌股关节对合异常患者,依据其对合不良的严重程度,分别采用关节镜下外侧支持带松解术及关节镜下髌周支持带平衡术进行治疗。结果外侧支持带松解组术前、术后Kujala关节评分分别为(59.49±2.52)、(75.15±3.40)分,髌周支持带平衡组分别为(60.35±3.17)、(88.62±3.74)分,2组术后髌股关节功能均得到改善,其Kujala髌股关节评分术前、术后差异均具有统计学意义(P<0.05)。结论关节镜下外侧支持带松解及髌周支持带平衡术均能有效去除髌股关节对合异常所致的应力失衡,防止髌股软骨面进一步磨损,减轻疼痛症状,改善髌骨活动度及关节伸屈功能。但关节镜下髌周支持带平衡术是治疗髌股关节对合异常更为有效的方法。     

髌股关节生物力学研究及其意义

本文综述了国外近年来采用压敏片及压力传感器对髌股关节接触力、接触面、运动力学、病理力学以及手术方法等进行生物力学实验研究的进展，指出关节接触面压力过高是髌股关节病发生的重要病因，胫骨结节前移术显著地降低了髌股关节接触力，是治疗髌股关节疾病有效的手术方法。     

股四头肌对髌股关节影响的临床和实验观察

目的　从临床和实验二个方面研究股四头肌对髌股关节运动的影响。方法　对一组 2 6例 5 2膝患者进行动力性CT检查 ,了解股四头肌收缩状态对髌股关节排列的影响 ;对一组标本进行生物力学实验 ,用压敏片技术直观地测得股四头肌肌力变化对髌股关节接触压力的影响。结果　静力性CT检查发现有 12膝髌骨半脱位和 14膝髌骨外倾 ,其余病例动力性CT检查又发现有 2 1膝在股四头肌收缩状态下髌骨半脱位 ,9膝髌骨外倾。力学实验中发现随股内侧肌肌力下降髌股接触面趋向外侧。结论　股四头肌各肌组的肌力不平衡对髌股关节的接触压力及髌骨位置有较大的影响 ,临床上应重视对股四头肌肌力的恢复。     

髌股关节置换术治疗单纯髌股关节骨关节炎

 目的 探讨髌股关节置换术治疗单纯髌股关节骨关节炎的疗效和影响因素。方法 回顾性分析2006年3月至2014年12月,采用髌股关节置换术治疗并获得随访的18例单纯髌股关节骨关节炎患者资料,男3例,女15例;年龄46~74岁,平均54岁;术前美国特种外科医院膝关节评分（hospital for special surgery knee score,HSS）为44~63分,平均（53.28±5.71）分;疼痛视觉模拟评分（visual analogue scale, VAS）为4~7分,平均（5.33±0.99）分。术前根据临床症状、体征和影像学资料严格把握手术指征,其中11例采用AVON髌股关节假体（Stryker公司）,7例采用Gender Solutions髌股关节假体（Zimmer公司）。术后第1天患膝即开始行主动和被动功能康复锻炼。结果 18例患者术后均获得随访,随访时间6~104个月,平均63.98个月。VAS,术后1个月（1.17±0.79）分（范围,0~3 分）,术后3个月（0.72±0.67）分（范围,0~2 分）,术后9个月疼痛基本消失;HSS,术后1个月（70.06±6.33）分（范围,61~80分）,术后3个月（86.06±5.12）分（范围,77~95分）,术后9个月（91.39±4.83）分（范围,82~97分）,末次随访（92.06±4.05）分（范围,84~97分）,其中优15例、良3例,优良率100%,较术前有明显改善。患者主观满意率94.4%（17/18）。1例患者术后2年再次出现上下楼梯时膝前疼痛,给予非甾体类抗炎药和适当减少活动后症状缓解。随访期间无一例患者出现切口感染、髌骨脱位、假体松动等并发症。结论 髌股关节置术后疗效与手术适应证、假体设计、手术技巧等因素密切相关,在选用合适的髌股关节假体、严格把握手术适应证、掌握好手术技巧及积极术后康复功能锻炼等基础上,采用髌股关节置换术治疗单纯髌股关节骨关节炎可以获得良好的疗效。     

Patellofemoral joint contact area increases with knee flexion and weight-bearing.

Patellofemoral pain is a common and debilitating disorder. Elevated cartilage stress of the patellofemoral joint is hypothesized to play a role in the onset of pain. Estimating cartilage stress requires accurate measurements of contact area. The purpose of this study was to estimate patellofemoral joint contact areas in a group of healthy, pain-free subjects during upright, weight-bearing conditions. Sixteen subjects (8 female, 8 male) were scanned in a GE Signa SP open configuration MRI scanner, which allowed subjects to stand or squat while reclining 25 degrees from vertical with the knee positioned at 0 degrees , 30 degrees , or 60 degrees of flexion. A custom-built backrest enabled subjects to be scanned without motion artifact in both weight-bearing (0.45 body weight per leg) and reduced loading conditions ('unloaded' at 0.15 body weight) at each knee flexion posture. Male subjects displayed mean unloaded patellofemoral joint contact areas of 210, 414, and 520 mm(2) at 0 degrees , 30 degrees and 60 degrees of knee flexion, respectively. Female subjects' unloaded contact areas were similar at full extension (0 degrees ), but significantly smaller at 30 degrees and 60 degrees (p<0.01), with mean values of 269 and 396 mm(2), respectively. When normalized by patellar dimensions (heightxwidth), contact areas were not different between genders. Under weight-bearing conditions, contact areas increased by an average of 24% (p<0.05). This study highlights the differences in patellofemoral joint contact area between gender, knee flexion postures, and physiologic loading conditions.     

Joint Awareness after Patellofemoral Arthroplasty Evaluated with the Forgotten Joint Score: A Comparison Study

ObjectiveThe aim of the present study was to compare the forgotten joint score (FJS) in patients with isolated patellofemoral osteoarthritis who underwent patellofemoral arthroplasty (PFA) versus those who underwent total knee arthroplasty (TKA) and to analyze the predictors of the FJS after PFA.MethodsFrom January 2014 to December 2017, a retrospective cohort study of 56 consecutive patients with isolated patellofemoral osteoarthritis underwent PFA and were included in the PFA group. The patients in the PFA group were matched in a 1:1 ratio based on age, sex, body mass index (BMI), and follow‐up duration; 56 patients with isolated patellofemoral osteoarthritis underwent cruciate‐retaining TKA (TKA group). The FJS, range of motion of the knee, and Knee Society Score were assessed at 1 and 3 years postoperatively. In addition, the associations between the potential influencing factors (age, sex, BMI, and preoperative Iwano score of the patellofemoral joint) and the FJS were analyzed using multiple linear regression in the PFA group.ResultsThere were no significant differences between the PFA and TKA groups regarding age (P = 0.316), sex (P = 0.832), BMI (P = 0.447), and follow‐up duration (P = 0.625). Postoperatively, the range of motion of the knee and Knee Society Score was significantly higher in the PFA group than the TKA group at both follow‐up points (P < 0.05). The PFA group had a significantly higher mean FJS than the TKA group at 1 year postoperatively (62.9 ± 12.3 vs 54.1 ± 14.2, P = 0.034) and 3 years postoperatively (63.3 ± 14.1 vs 55.6 ± 16.4, P = 0.042). In the PFA group, multiple linear regression analysis showed that older age was positively correlated with the FJS, while a higher BMI was negatively correlated with the FJS.ConclusionThe patients with isolated patellofemoral osteoarthritis who underwent PFA were more likely to forget the artificial joint and, consequently, may experience a higher degree of satisfaction. In addition, we identified two preoperative patient‐related factors (age and BMI) that may predict the FJS after PFA, which might help in chosing the most appropriate operation.     

髌骨横轴-股骨通髁线角在评估髌股关节排列紊乱中的作用

目的 探讨MRI上髌骨横轴-股骨通髁线角在评估髌股关节排列紊乱中的作用.方法 从2005年1月至2006年12月行膝关节镜手术的病例中选取主诉膝前痛、膝关节镜检查证实存在髌股关节软骨损伤的患者111例为损伤组;无膝前痛、膝关节镜检查证实髌股关节完好、仅有单纯半月板损伤的患者124例为对照组.所有研究对象均行膝关节MR检查,在MRI轴位图像上测量外侧髌股角、髌骨倾斜角(前)(以股骨前髁连线为参考)、髌骨倾斜角(后)(以股骨后髁连线为参考)及髌骨横轴-股骨通髁线角.为排除年龄与性别对结果的影响,损伤组与对照组按照性别相同、年龄相差3岁以内随机进行1:1配对,配对后采用配对没计资料t检验分析各参数在评估髌股关节排列紊乱中的作用.结果 配对后外侧髌股角、髌骨倾斜角(前)、髌骨倾斜角(后)及髌骨横轴-股骨通髁线角在损伤组依次为18.94°±7.35°、6.89°±7.58°、6.89°±7.55°、6.55°±7.14°,在对照组依次为20.55°±6.25°、4.11°±4.02°、3.86°4±2.95°、3.76°±2.84°.两组外侧髌股角差异无统计学意义,而髌骨倾斜角(前、后)及髌骨横轴-股骨通髁线角差异有统计学意义.损伤组中股骨前髁骨缺损15例,股骨后髁骨缺损8例,未见股骨内、外上髁骨缺损.对照组骨质良好无缺损.结论 髌骨横轴-股骨通髁线角是评估髌股关节排列紊乱的有效参数.     

改良胫骨结节垫高术治疗髌股间疼痛

目的 分析髌股间疼痛的原因和改进其手术方法。方法 分别患有髌股关节炎、髌骨力线不正、髌骨半脱有软骨软化或髌股外侧间隔压力过高综合征（ＥＬＰＳ）等的髌股间疼痛的患者２７例，采用发言奶胫骨结节势高术，结合切除局部炎变的滑膜。结果 ２７例患者中２４例疗效优良。结论 髌股单产产痛与髌骨软骨下骨板硬化，髌股关节边缘局限性滑膜炎有关。     

The Effects of Bone Resection Depth and Malalignment on Strain in the Proximal Tibia After Total Knee Arthroplasty

The clinical significance of tibial resection depth in total knee arthroplasty (TKA) is not clearly understood. The purpose of this study was to quantify the effect of tibial resection depth in TKA on tibial loading. Tibiae were coated with a photoelastic resin enabling full-field dynamic shear strain quantification in the tibial metaphysis during TKA loading. A standard resection level (5 mm) was compared to a resection level 15 mm distal to the joint line. Both had appropriate-sized tibial components. With 15 mm of tibial resection, strains increased up to 281% in the proximal and peripheral regions of the tibia during neutral loading and up to 315% anteriorly and 197% peripherally during varus loading. Distal resection levels result in significant smaller component size and relatively posterior and peripheral displacement of the implant. Changes in loading patterns in specimens with increased tibial resection depths have not previously been described.     

髌股关节疾病的非手术治疗与关节镜手术治疗比较

目的 探索治疗髌股关节疾病的有效微创方法。方法 对296例髌股关节疾病患者,严格按照Merchant分型进行分类后,随机分为两组。一组采用非手术治疗;另一组根据具体情况,分别施行不同的关节镜手术;术后随访两组膝关节的功能恢复情况,并进行统计学比较。结果术后随访时间3~28个月,平均18.6个月。膝关节术后功能恢复程度参考HSS膝关节评分标准进行评定。非手术治疗组平均优良率为56.0％;而关节镜组平均优良率达91.7％。各组不同治疗后结果差异有统计学意义(P<0.05)。结论运用膝关节镜手术治疗髌股关节疾病,具有微创、高效的特点,值得推广。