旋转截骨术是治疗外侧髌骨脱位的一项相关手术：国际髌骨研究小组的专家调查

IF 2.7 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2025-02-12 DOI:10.1002/jeo2.70116

Guido Wierer, Danko Milinkovic, Gerd Seitlinger, Michael Liebensteiner, William Post, Philipp W. Winkler

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引用次数: 0

摘要

目的评价髌股专家在治疗外侧髌骨脱位（LPD）患者下肢扭转畸形方面的现有知识，并发现潜在的争议。方法对所有活跃的国际髌股研究小组（IPSG）成员进行在线调查，这些成员代表了对髌股关节疾病有特定兴趣和经验的国际骨科医生样本。该调查包括21个单项和多项选择题，并在2022年至2023年间通过电子邮件分发。结果35人（54%）完成问卷调查。在首次和复发性髌骨脱位后，根据临床检查（分别为43%和49%）、常规（分别为6%和23%）或根本不做（分别为51%和29%），应答专家会进行髋关节-膝关节-踝关节磁共振成像或计算机断层扫描。三分之二的专家进行股骨旋转截骨术，37%的专家进行胫骨旋转截骨术。这些外科医生中的大多数（分别为61%和69%）每年进行的股骨或胫骨旋转截骨术少于5例。进行旋转截骨术的最重要因素是异常扭转（100%）、异常步态（57%）、翻修病例（74%）和复发性髌骨不稳（61%）。大多数外科医生（65%）同意进行旋转截骨术时，股骨前扭转为30°，胫骨外扭转为35°的临界值，但首选的测量技术各不相同。结论下肢扭转畸形是治疗复发性LPD患者的临床重要课题。虽然病例量很低，但大多数专家都采用旋转截骨术。外科医生之间的诊断和治疗方法有很大的重叠，但进行旋转截骨术的适应症和临界值必须进一步确定。研究设计调查。证据等级V级。

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Derotational osteotomy is a relevant procedure in the management of lateral patellar dislocation: An expert survey of the International Patellofemoral Study Group

Purpose

To evaluate current knowledge and discover potential controversies in treating torsional deformities of the lower limb in patients with lateral patellar dislocation (LPD) among patellofemoral experts.

Methods

An online survey was distributed to all active International Patellofemoral Study Group (IPSG) members, representing an international sample of orthopaedic surgeons with a specific interest and experience in patellofemoral joint disorders. The survey included 21 single- and multiple-choice questions and was distributed by email between 2022 and 2023.

Results

Thirty-five members (54%) completed the questionnaire. The responding experts conduct a hip–knee–ankle magnetic resonance imaging or computed tomography following first-time and recurrent patellar dislocation based on clinical examination (43% and 49%, respectively), routinely (6% and 23%, respectively), or not at all (51% and 29%, respectively). Two thirds of the experts perform derotational osteotomies of the femur, and 37% perform derotational osteotomies of the tibia. Most of these surgeons (61% and 69%, respectively) perform less than five derotational osteotomies of the femur or tibia per year. The most important factors for performing derotational osteotomy are abnormal torsion (100%), abnormal gait pattern (57%), revision cases (74%) and recurrent patellar instability (61%). Most surgeons (65%) agree on a cut-off value of >30° of femoral ante-torsion and >35° of external tibial torsion to perform derotational osteotomy, but the preferred measurement techniques vary.

Conclusion

Torsional deformities of the lower limb are a clinically relevant topic in the management of patients with recurrent LPD. Although the caseload is low, most experts perform derotational osteotomies. Diagnostic and therapeutic algorithms overlap widely between surgeons, but the indication and cut-off values for performing derotational osteotomy must be further established.