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复发性髌骨脱位危险因素研究现状及进展
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Abstract:
复发性髌骨脱位是以膝关节周围持续弥漫性钝痛、膝关节不稳、肿胀以及髌骨反复向外侧脱位为主要症状的疾病。其危险因素尚不明确，目前认为其危险因素主要包括：膝关节外侧支持结构挛缩、股四头肌功能障碍(股内侧斜肌)、内侧髌股韧带异常、股骨滑车发育不良、膝外翻畸形、胫骨结节外侧化(扭转)、股骨前倾增大、高位髌骨、多发韧带松弛、扁平足、髌骨发育不良、胫骨结节–滑车间沟距离(TT-TG)增大、髌骨倾斜、家族基因遗传、BMI、Q角增大、性别、膝关节扭转过大、第一次脱位年龄等。治疗方式包括非手术治疗与手术治疗。手术治疗以内侧髌股韧带重建手术为基础，根据其危险因素，可结合行外侧支持带松解术、胫骨结节移位手术与滑车成形术。然而，因其危险因素复杂多样，很多患者术后仍存在膝关节不适症状甚至再次脱位。随着对膝关节及整个下肢解剖和生物力学的研究的深入细化，复发性髌骨脱位的危险因素也逐渐被剖析出来，但相对完整的危险因素尚未形成。本文针对目前有关复发性髌骨脱位危险因素的研究现状及最新进展进行综述，以便更精准地指导临床个体化治疗。
Recurrent patellar dislocation (RPD)is a clinical condition characterized by persistent diffuse dull pain around the knee joint, instability of the knee, swelling, and recurrent lateral dislocation of the patella. Despite extensive research, the etiological risk factors remain incompletely understood. Current evidence suggests that the primary risk factors include: lateral retinacular contracture, medial patellofemoral ligament (MPFL) dysfunction; quadriceps dysfunction (especially vastus medialis obliquus, VMO); trochlear dysplasia, femoral anteversion, genu valgum, tibial tuberosity lateralization (external torsion), increased TT-TG distance, patella alta, generalized ligamentous laxity, flat feet; patellar tilt, familial inheritance, elevated BMI, increased Q-angle, female gender, excessive knee torsion, and younger age at first dislocation. Treatment strategies for recurrent patellar dislocation (RPD) primarily include non-surgical interventions and surgical management. Among surgical options, medial patellofemoral ligament (MPFL) reconstruction serves as the cornerstone procedure, often supplemented by additional procedures—such as lateral retinacular release, tibial tubercle osteotomy, or trochleoplasty—based on individual risk factors. However, due to the complex and multifactorial nature of RPD etiology, many patients continue to experience postoperative knee discomfort or even recurrent dislocation. With advancing research on knee and lower extremity anatomy and biomechanics, the risk factors for RPD have been increasingly elucidated. Nevertheless, a comprehensive and universally accepted risk factor profile remains elusive. This review aims to summarize the current understanding and recent advances in RPD risk factor research, with the ultimate goal of providing precise guidance for personalized clinical management.
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