Computational analysis of factors contributing to patellar dislocation
Computational analysis of factors contributing to patellar dislocation
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DOI：
10.1002/jor.23041
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发表时间：
2016-03-01
影响因子：
2.8
通讯作者：
Rullkoetter, Paul J.
中科院分区：
文献类型：
--
作者：
Fitzpatrick, Clare K.;Steensen, Robert N.;Rullkoetter, Paul J.
最初发生的髌骨脱位的治疗通常是保守治疗；然而，几乎一半的患者会经历继发性或多发性脱位(S)。患者经常接受多次手术，但未能治疗潜在的解剖异常。本研究的目的是评估关键的易感解剖因素与髌骨脱位之间的相互作用，并确定增加复发外侧脱位风险的异常因素组合。有四个因素与髌骨外侧脱位有关(骨沟角度、Insall-Salati比率、胫骨结节-滑车沟距离和股骨前倾角)。建立了髌股关节的有限元模型，并将其参数化，以便可以应用每个因素的值，并相应地修改模型的几何形状/排列方式。在单独的计算模拟中产生了这四种因素的100种组合，并记录了由此产生的髌股关节的运动学和力。沟角对约束的影响最大。通常需要多种异常因素才能产生本分析中观察到的最极端的髌骨排列。了解复发性髌骨外侧脱位患者的潜在解剖因素及其对关节力学的影响，将有助于根据患者的具体情况确定最佳治疗路径。(C)2015年骨科研究会。由Wiley期刊公司出版，J Orthop Res 34：444-453,2016。
Treatment for an initial incidence of patellar dislocation is usually conservative management; however, almost half of patients experience a subsequent, or multiple, dislocation(s). Patients often undergo multiple procedures which fail to treat the underlying anatomic abnormalities. The objective of this study was to evaluate interactions between key predisposing anatomic factors to patellar dislocation and identify combinations of abnormal factors which increase the risk of recurrent lateral dislocation. Four factors associated with lateral patellar dislocation were identified (sulcus angle, Insall-Salvati ratio, tibial tubercle-trochlear groove distance, and femoral anteversion). A finite element model of the patellofemoral joint was developed and parameterized so that a value for each factor could be applied and the model geometry/alignment would be modified accordingly. 100 combinations of the four factors were generated in separate computational simulations and resulting kinematics and forces of the patellofemoral joint were recorded. Sulcus angle was the most impactful factor on constraint. Multiple abnormal factors were generally required to produce the extremes of patellar alignment observed in this analysis. Understanding the underlying anatomic factors, and their effect on joint mechanics, for patients with recurrent lateral patellar dislocation will aid in determining optimal treatment pathways on a patient-specific basis. (c) 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:444-453, 2016.