ДИАГНОСТИКА ОРТОПЕДИЧЕСКОЙ ПАТОЛОГИИ ПАТЕЛЛОФЕМОРАЛЬНОГО СУСТАВА. ОБЗОР ЛИТЕРАТУРЫ
Актуальность. Патология пателлофеморального сустава (ПФС) – распространенная, однако недостаточно изученная проблема. По данным некоторых авторов, примерно 15 % впервые обратившихся пациентов имеют изолированную пателлофеморальную патологию. Еще у 25 % пациентов пателлофеморальные симптомы являются вторичным проявлением других заболеваний, таких как нестабильность передней крестообразной связки и разрывы менисков. В диагностике патологии ПФС важны тщательно собранный анамнез и полноценное клиническое обследование. Цель данного обзора обобщить данные по диагностике ортопедической патологии пателлофеморального сустава Стратегия поиска. Был проведен литературный поиск в электронных базах данных PubMed/Scopus/MEDLINE, охватывающий последние три десятилетия по ключевым словам: пателлофеморальный сустав, остеоартрит, тибиофеморальный сустав, синдром пателлофеморальной боли, диагностика, методы. Критерии включения: доступные полнотекстовые статьи по оригинальным исследованиям с 1987 года, диагнозы первичного остеоартрита, критерии исключения: статьи - описание отдельных случаев, статьи на других иностранных языках, кроме английского. 48 статей включены в анализ. Результаты. Ортопедическая патология ПФС является серьезной, достаточно распространенной, но не достаточно изученной проблемой. В диагностике патологии ПФС важны тщательно собранный анамнез и полноценное клиническое обследование. Учитывая большой спектр ортопедических заболеваний, характеризующихся сходными клиническими и анамнестическими данными, в дифференциальной диагностике и верификации диагноза целесообразно использовать весь арсенал современных методов исследования (рентгенограммы в различных проекциях, КТ, МРТ), дополняющих традиционные. Заключение. В дифференциальной диагностике и верификации диагноза патологии пателлофеморального сустава целесообразно использовать весь арсенал современных методов исследования (рентгенограммы в различных проекциях, КТ, МРТ), дополняющих традиционные.
Кенес Р. Акильжанов 1,2, Марат А. Жанаспаев 1, 1 Кафедра травматологии и ортопедии, Государственный медицинский университет города Семей, г. Семей, Республика Казахстан; 2 Отделение Политравмы, Городская больница №1, г. Павлодар, Республика Казахстан
Литература: 1. Архипов C.B. Клиника, диагностика и лечение вывихов надколенника у взрослых: Дис. канд. мед. наук. - М.,1985.-115 с. 2. Гиршин С.Г. Оперативное лечение поврежде-ний коленного сустава в остром периоде травмы: Дис. д-ра мед. наук. - М., 1993.-227 с. 3. Котельников Г.П. Клинико-экспериментальные аспекты реабилитации больных с посттравматической нестабильностью коленного сустава: Дис. д-ра мед. наук. - Куйбышев, 1988.-243 с. 4. Миронов С.П., Миронова З.С., Орлецкий А.К. Оперативное лечение повреждений крестообразных связок коленного сустава (ретроспективный анализ) // Вестн. травматологии и ортопедии. 2001. № 2. С.51-55. 5. Орлецкий А.К. Малоинвазивный подход к лечению синдрома хронического перенапряжения опорно-двигательного аппарата // Эндоскопич. Хирургия. 2001. № 6. С.49-57. 6. Aglietti P., Insall J.N., Cerulli G. Patellar pain and incongruence I: measurements of incongruence // Clin Orthop 1983;176:217-224. 7. Blumensaat C. Die Lageabweichungen und Verrenkungen der Kneesheibe // Ergeb Chir Ortho 1938;31:149. 8. Conlan T., Garth W.P. Jr., Lemons J.E. Evaluation of the medial soft tissue restraints of the extensor mechanism of the knee // J Bone Joint Surg Am 1993;75:682-693. 9. DeHaven K., Dolan W., Mayor P. Chondromalacia patellae in athletes: clinical presentation and conservative management // Am J Sports Med 1979;77:5-11. 10. Dye S., Boll D. Radionuclide imaging of the patellofemoral joint in young adults with anterior knee pain // Orthop Clin North Am 1986;17:249-261. 11. Dupont J.Y. Le genou douloureux «rotulien» // Revue pratitien.-1998.-Vol.48.-№ 16.-P.1781-1786. 12. Feller J.A., Feagin J.A. Jr., Garrett W.E. Jr. The medial patellofemoral ligament revisited: an anatomical study // Knee Surg Sports Traumatol Arthrosc 1993;1:184-186 13. Fulkerson J.P. Disorders of the patellofemoral joint. - Baltimore: Williams&Wilkins, 1997. - 365 p. 14. Fulkerson J., Gossling H. Anatomy of the knee joint lateral retinaculum. Clin Orthop 1980;153:183. 15. Fulkerson J.P., Tennant R., Jaivin J.S., et al. Histologic evidence of retinacular nerve surgery associated with patellofemoral malalignment. Clin Orthop 1985;197:196-205. 16. Fulkerson J., Shea K. Disorders of patellofemoral alignment. J Bone Joint Surg 1990;72:1424-1429. 17. Fulkerson J.P., Kalenak A., Rosenberg T.D., et al. Patellofemoral pain. Instr Course Lect 1992;41:57-71. 18. Fulkerson J., Schulzer S., Ramsby G., et al. Computerized tomography of the patellofemoral joint before and after lateral release of realignment. Arthroscopy 1987;3:19-24. 19. Goodfellow J., Hungerford D., Zindel M. Patellofemoral joint mechanics and pathology: functional anatomy of the patellofemoral joint. J Bone Joint Surg Br 1976;58:287-290. 20. Greenfield M., Scott W. Arthroscopic evaluation and treatment of the patellofemoral joint. Orthop Clin North Am 1992;23:587-600. 21. Heegaard J., Leyvraz P.E., Van Kampen A., et al. Influence of soft structures on patellar three dimensional tracking. Clin Orthop 1994;299:235-243. 22. Holmes Sw.Jr., Clancy W.G.Jr. Clinical classification of patellofemoral pain and dysfunct // J. Orthop. Sport. Phys. Ther.-1998.-Vol.28.- № 5.-P.299-306. 23. Hungerford J., Barry M. Biomechanics on the patellofemoral joint. Clin Orthop 1979;149:9-15 24. Hughston J., Walsh W., Puddu G. Patellar subluxation and dislocation. Philadelphia: WB Saunders, 1984. 25. Insall J., Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-104. 26. Karlson J, Thomee R, Sward L. Eleven year follow-up of patellofemoral pain syndrome. Clin J Sports Med 1996;6:22-26 27. Koskinen S.K., Kujala U.M. Patellofemoral relationships and distal insertion of the vastus medialis muscle: a magnetic resonance imaging study in nonsymptomatic subjects and in patients with patellar dislocation. Arthroscopy 1992;8465-468. 28. Kolowich P.A., Paulos L.E., Rosenberg T.D,. et al. Lateral release of the patella: indications and contraindications. Am J Sports Med 1990;18:359-365. 29. Laurin C., Dussault R., Levesque H. The tangential x-ray investigation of the patellofemoral joint. Clin Orthop 1979;144:16-26. 30. Iossifidis A., Brueton R.N., Nunan T.O. Bone scintigraphy in painful bipartite patella. Eur J Nucl Med 1995;22:1212-1213. 31. Martinez S., Korobkin M., Fonder F.B., et al. Diagnosis of patellofemoral malalignment by computed tomography. J Comput Assist Tomogr 1983;7:1050-1053. 32. Merchant A.C. Patellofemoral disorders: biomechanics, diagnosis, and nonoperative treatment. In: McGinty JB, ed. Operative arthroscopy. New York: Raven Press, 1990:273. 33. Merchant A., Mercer R., Jacobson R., et al. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974;56:1391-1396. 34. Müller W. Hackenbruch W. Surgery and Arthroscopy of the Knee.-Berlin: Springer Verlag, 1988.-730 p. 35. Nakanishi K., Inoue M., Harada K., et al. Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging. Br J Radiol 1992;65:662-667. 36. Sallay P.I., Poggi J, Speer KP, et al. Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med 1996;24:52-60. 37. Sanchis-Alfonso V., Sosello-Sastre E. Immunohistochemical analisis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment: a neyroanatomic basis for anterior knee pain in the active young patient. Am J Sports Med 2000;28:725-731. 38. Sanchis-Alfonso V., Sosello-Sastre E., Monteagudo-Castro C., et al. Quantitative analysis of nerve changes in the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment: a preliminary study. Am J Sports Med 1998;26:703-709. 39. Sutton F., Thompson C., Lipke J., et al. The effect of patellectomy and knee function. J Bone Joint Surg Am 1976;58:537-540. 40. Shellock F., Mink J., Fox J. Patellofemoral joint, kinematic MR imaging to assess tracking abnormalities. Radiology 1988;168:551-553. 41. Shellock F., Mink J., Deutsh A., et al. Evaluation of patients with persistent symptoms after lateral retinacular release by kinematic magnetic resonance imaging of the patellofemoral joint. Arthroscopy 1990;6:226-234. 42. Shellock F., Mink J., Deutsh A, et al. Kinematic MR imaging of the patellofemoral joint: comparison of passive positioning and active movement techniques. Radiology 1992;184:574-577. 43. Schutzer S., Ramsby G., Fulkerson J. The evaluation of patellofemoral pain using omputerized tomography: a preliminary study. Clin Orthop 1986;204:286-293. 44. Van Leersum M.D., Schweitzer M.E., Gannon F., et al. Thickness of patellofemoral articular cartilage as measured on MR imaging: sequence comparison of accuracy, reproducibility, and interobserver variation. Skeletal Radiol 1995;24:431-435. 45. Warren L.F., Marshall J.L. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am 1979;61:56-62. 46. Wiberg G. Roentgenographic and anatomic studies on the patellofemoral joint with special reference to chondromalacia patella. Acta Orthop Scand 1941; 12:319-410. 47. Whitelaw G., Rullo D., Markowitz H., et al. A conservative approach to anterior knee pain. Clin Orthop 1989;246:234-237 48. Witvrouw E., Lysens R., Bellemans J., et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two year prospective study. Am J Sports Med 2000;28:480-489. References: 1. Arkhipov S.V. Klinika, diagnostika i lechenie vyvikhov nadkolennika u vzroslykh: Dis. kand. med. nauk. [Clinic, diagnosis and treatment of patella dislocations in adults. Cand. Diss.]-M.,1985. - 115 p. [in Russian]. 2. Girshin S.G. Operativnoye lechenie povrezhdeniy kolennogo sustava v ostriom periode travmy [Operative treatment of knee joint in acute phase of trauma. Doct. Diss.]-М., 1993.-227 p. [in Russian]. 3. Kotelnikov G.P. Kliniko experimantalnye aspekty reabilitacii bolnych s posttravmaticheskoy nestabilnostyu kolennogo sustava [Clinical and experimental aspects of rehabilitation of patients with posttraumatic instability of knee joint: Doct. Diss.] - Kuibyshev, 1988. - 243 p. [in Russian]. 4. Mironov S.P., Mironova Z.S., Orletsskiy A.K. Operativnoye lechenie povrezhdeniy krestoobraznych svyazok kolennogo sustava (retrospectivniy analis) Operative treatment of cruciate ligament injuries of knee joint (retrospective analysis). Vestn. Traumatology and orthopedics. - 2001. - № 2. - P.51-55. p. [in Russian]. 5. Orletskiy A.K. Maloinvasivniy podhod k lecheniyu sindroma chronicheskogo perenapryazheniya oporno-dvigatelnogo apparata Minimally invasive approach in treatment of chronic stress of the musculoskeletal system // Endoscopy surgery. 2001. № 6. P.49-57. p. [in Russian]. 6. Aglietti P., Insall J.N., Cerulli G. Patellar pain and incongruence I: measurements of incongruence. Clin Orthop. 1983;176:217-224. 7. Blumensaat C. Die Lageabweichungen und Verrenkungen der Kneesheibe. Ergeb Chir Ortho 1938;31:149. 8. Conlan T., Garth W.P. Jr., Lemons J.E. Evaluation of the medial soft tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993;75:682-693. 9. DeHaven K., Dolan W., Mayor P. Chondromalacia patellae in athletes: clinical presentation and conservative management. Am J Sports Med. 1979;77:5-11. 10. Dye S., Boll D. Radionuclide imaging of the patellofemoral joint in young adults with anterior knee pain. Orthop Clin North Am. 1986;17:249-261. 11. Dupont J.Y. Le genou douloureux «rotulien». Revue pratitien. 1998. Vol.48. № 16. P.1781-1786. 12. Feller J.A., Feagin J.A. Jr., Garrett W.E. Jr. The medial patellofemoral ligament revisited: an anatomical study. Knee Surg Sports Traumatol Arthrosc 1993;1:184-186 13. Fulkerson J.P. Disorders of the patellofemoral joint.-Baltimore: Williams&Wilkins, 1997.- 365 p. 14. Fulkerson J., Gossling H. Anatomy of the knee joint lateral retinaculum. Clin Orthop 1980;153:183. 15. Fulkerson J.P., Tennant R., Jaivin J.S., et al. Histologic evidence of retinacular nerve surgery associated with patellofemoral malalignment. Clin Orthop 1985;197:196-205. 16. Fulkerson J., Shea K. Disorders of patellofemoral alignment. J Bone Joint Surg. 1990;72:1424-1429. 17. Fulkerson J.P., Kalenak A., Rosenberg T.D., et al. Patellofemoral pain. Instr Course Lect. 1992;41:57-71. 18. Fulkerson J., Schulzer S., Ramsby G., et al. Computerized tomography of the patellofemoral joint before and after lateral release of realignment. Arthroscopy. 1987;3:19-24. 19. Goodfellow J., Hungerford D., Zindel M. Patellofemoral joint mechanics and pathology: functional anatomy of the patellofemoral joint. J Bone Joint Surg Br. 1976;58:287-290. 20. Greenfield M., Scott W. Arthroscopic evaluation and treatment of the patellofemoral joint. Orthop Clin North Am 1992;23:587-600. 21. Heegaard J., Leyvraz P.E., Van Kampen A., et al. Influence of soft structures on patellar three dimensional tracking. Clin Orthop. 1994;299:235-243. 22. Holmes Sw.Jr., Clancy W.G.Jr. Clinical classification of patellofemoral pain and dysfunct. J. Orthop. Sport. Phys. Ther.-1998.-Vol.28.- № 5.-P.299-306. 23. Hungerford J., Barry M. Biomechanics on the patellofemoral joint. Clin Orthop. 1979;149:9-15 24. Hughston J., Walsh W., Puddu G. Patellar subluxation and dislocation. Philadelphia: WB Saunders, 1984. 25. Insall J., Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-104. 26. Karlson J, Thomee R, Sward L. Eleven year follow-up of patellofemoral pain syndrome. Clin J Sports Med. 1996;6:22-26 27. Koskinen S.K., Kujala U.M. Patellofemoral relationships and distal insertion of the vastus medialis muscle: a magnetic resonance imaging study in nonsymptomatic subjects and in patients with patellar dislocation. Arthroscopy. 1992;8465-468. 28. Kolowich P.A., Paulos L.E., Rosenberg T.D,. et al. Lateral release of the patella: indications and contraindications. Am J Sports Med. 1990;18:359-365. 29. Laurin C., Dussault R., Levesque H. The tangential x-ray investigation of the patellofemoral joint. Clin Orthop. 1979;144:16-26. 30. Iossifidis A., Brueton R.N., Nunan T.O. Bone scintigraphy in painful bipartite patella. Eur J Nucl Med. 1995;22:1212-1213. 31. Martinez S., Korobkin M., Fonder F.B., et al. Diagnosis of patellofemoral malalignment by computed tomography. J Comput Assist Tomogr. 1983;7:1050-1053. 32. Merchant A.C. Patellofemoral disorders: biomechanics, diagnosis, and nonoperative treatment. In: McGinty JB, ed. Operative arthroscopy. New York: Raven Press, 1990:273. 33. Merchant A., Mercer R., Jacobson R., et al. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am. 1974;56:1391-1396. 34. Müller W., Hackenbruch W. Surgery and Arthroscopy of the Knee. Berlin: Springer Verlag, 1988.-730 p. 35. Nakanishi K., Inoue M., Harada K., et al. Subluxation of the patella: evaluation of patellar articular cartilage with MR imaging. Br J Radiol 1992;65:662-667. 36. Sallay P.I., Poggi J, Speer KP, et al. Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med. 1996;24:52-60. 37. Sanchis-Alfonso V., Sosello-Sastre E. Immunohistochemical analisis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment: a neyroanatomic basis for anterior knee pain in the active young patient. Am J Sports. Med 2000;28:725-731. 38. Sanchis-Alfonso V., Sosello-Sastre E., Monteagudo-Castro C., et al. Quantitative analysis of nerve changes in the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment: a preliminary study. Am J Sports Med. 1998;26:703-709. 39. Sutton F., Thompson C., Lipke J., et al. The effect of patellectomy and knee function. J Bone Joint Surg Am. 1976;58:537-540. 40. Shellock F., Mink J., Fox J. Patellofemoral joint, kinematic MR imaging to assess tracking abnormalities. Radiology. 1988;168:551-553. 41. Shellock F., Mink J., Deutsh A., et al. Evaluation of patients with persistent symptoms after lateral retinacular release by kinematic magnetic resonance imaging of the patellofemoral joint. Arthroscopy. 1990;6:226-234. 42. Shellock F., Mink J., Deutsh A, et al. Kinematic MR imaging of the patellofemoral joint: comparison of passive positioning and active movement techniques. Radiology. 1992;184:574-577. 43. Schutzer S., Ramsby G., Fulkerson J. The evaluation of patellofemoral pain using omputerized tomography: a preliminary study. Clin Orthop. 1986;204:286-293. 44. Van Leersum M.D., Schweitzer ME, Gannon F, et al. Thickness of patellofemoral articular cartilage as measured on MR imaging: sequence comparison of accuracy, reproducibility, and interobserver variation. Skeletal Radiol. 1995;24:431-435. 45. Warren L.F., Marshall J.L. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am. 1979;61:56-62. 46. Wiberg G., Roentgenographic and anatomic studies on the patellofemoral joint with special reference to chondromalacia patella. Acta Orthop Scand. 1941; 12:319-410. 47. Whitelaw G., Rullo D., Markowitz H., et al. A conservative approach to anterior knee pain. Clin Orthop. 1989;246:234-237 48. Witvrouw E., Lysens R., Bellemans J., et al. Intrinsic risk factors for the development of anterior knee pain in an athletic population: a two year prospective study. Am J Sports Med. 2000;28:480-489.
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Акильжанов К.Р., Жанаспаев М.А. Диагностика ортопедической патологии пателлофеморального сустава. Обзор литературы // Наука и Здравоохранение. 2018. 5 (Т.20). С. 31-41. Akilzhanov K.R., Zhanaspaev M.A. Diagnostics of orthopedic pathology of patellofemoral joint. Literature review. Nauka i Zdravookhranenie [Science & Healthcare]. 2018, (Vol.20) 5, pp. 31-41. Акильжанов К.Р., Жанаспаев М.А. Пателлофеморалды буынның ортопедиялық патологиясының диагностикасы. Әдебиеттік шолу // Ғылым және Денсаулық сақтау. 2018. 5 (Т.20). Б. 31-41.