内侧髌股韧带重建术中股骨侧定位点研究进展  

Research progress on femoral attachment positioning during medial patellofemoral ligament reconstruction

作　　者：闫鹏安 路凡 蔡逸帆 闫振兴 魏雨乔 孙重霄 耿彬[1,2,3] 夏亚一 YAN Peng’an;LU Fan;CAI Yifan;YAN Zhenxing;WEI Yuqiao;SUN Chongxiao;GENG Bin;XIA Yayi(Department of Orthopaedics,the Second Hospital of Lanzhou University,Lanzhou Gansu,730030,P.R.China;Orthopaedic Clinical Research Center of Gansu Province,Lanzhou Gansu,730030,P.R.China;Intelligent Orthopaedic Industry Technology Center of Gansu Province,Lanzhou Gansu,730030,P.R.China)

机构地区：[1]兰州大学第二医院骨科,兰州730030 [2]甘肃省骨科临床医学研究中心,兰州730030 [3]甘肃省智能骨科行业技术中心,兰州730030

出　　处：《中国修复重建外科杂志》2024年第10期1276-1282,共7页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81960403、81874017、82060405)。

摘　　要：目的对内侧髌股韧带(medial patellofemoral ligament,MPFL)重建术中股骨侧定位的研究进展进行综述,为临床提供参考。方法广泛查阅国内外关于MPFL重建术中股骨侧定位研究文献,并对其归纳和总结。结果MPFL是限制髌骨外移的主要韧带,因此MPFL重建术是治疗髌骨脱位的主要术式,术中股骨侧定位准确性会显著影响手术疗效。目前,MPFL股骨侧定位主要有影像学定位法、骨性标志定位法和新技术定位法。其中,影像学定位法主要采用“Schöttle点”定位法,对透视体位要求较高,必须在股骨标准侧位透视下才能获得准确定位;骨性标志定位法主要通过在体表触摸或者解剖内收肌结节、股骨内上髁等骨性标志进行定位,其不足是定位不够精准、术中视野暴露要求较高,需要较大切口。为解决单纯骨性标志定位法不精确并且操作难度大的问题,近年来临床开始采用骨性标志结合关节镜、3D打印技术及机器人辅助定位等方法,通过术前制备导航模板、提前规划定位路径或在术中直接使用机器人进行辅助定位,获得了良好效果。结论MPFL重建术中股骨侧准确定位较为关键,目前定位方法还需要进一步完善优化,以期达到精准快速定位目标,结合计算机图像识别矫正技术和术中体位辅助用具有望解决这一难题。Objective To review research progress on femoral attachment positioning during medial patello-femoral ligament(MPFL)reconstruction,so as to provide a reference for accurate positioning in clinic.Methods The literature at home and abroad on femoral attachment positioning during MPFL reconstruction was extensively reviewed and summarized.Results MPFL is the main ligament that restricts patellar outward migration,so MPFL reconstruction is the main treatment for patellar dislocation,but the accuracy of intraoperative femoral attachment positioning will significantly affect the effectiveness.At present,there are three main methods for femoral attachment positioning in MPFL reconstruction,including imaging positioning,bony landmark positioning,and new technology.Among them,the main imaging positioning method is the“Schöttle point”method,but it has high requirements for fluoroscopic positioning,and can only be accurately positioned under standard lateral fluoroscopy of the femur.The bony landmark positioning method mainly locates the femoral attachment by touching or dissecting the bony landmarks such as adductor tubercles and medial epicondyle of femur,but its disadvantages are that the positioning is not accurate enough,the intraoperative visual field exposure requirements are high,and a large incision is required.In order to avoid the problem that the simple bony landmark positioning method,in recent years,the combination of bony landmarks combined with arthroscopy,three-dimensional(3D)printing technology,and robot-assisted positioning methods have begun to be used in clinical practice.New technology localization methods have shown good results by preparing guides before operation,planning positioning paths in advance,or directly using robots to assist positioning during operation.Conclusion The accurate positioning of the femoral attachment in MPFL reconstruction is crucial,and the method of accurate and rapid intraoperative determination needs to be further improved and optimized.In the future,it is expected t

关 键 词：髌骨脱位 内侧髌股韧带重建 股骨侧定位点 研究进展 

分 类 号：R687.3[医药卫生—骨科学]