冠状面胫股关节半脱位研究现状

Current research of coronal tibiofemoral subluxation of the knee: a systematic review

摘要:

［目的］评价冠状位胫股关节半脱位（coronal tibiofemoral subluxation, CTFS）的影像学测量方法、病理机制及临床意义。［方法］检索 PubMed, Embase, Cochrane Library, Web of Science 等国际医学数据库中，以 tibiofemoral, tibial and femoral, insta- bility, subluxation, dislocation, CTFS 等作为关键词，按纳入标准人工筛选相关文献。［结果］最终共纳入文献 18 篇，其中 16 篇报道了影像学测量方法，6 篇为机制和危险因素研究，10 篇报道了临床问题。CTFS 的 X 线测量方法目前尚无统一的标准。目前关于 CTFS 的发生机制研究并不多且仍存在争议，较为认可的理论是由于膝关节外侧韧带结构较内侧松弛。CTFS 是一种常见的 KOA 影像学表现，但其在 KOA 严重程度的判断上并无价值。而在临床症状方面，目前研究仍存在争议。［结论］CTFS 主流观点认为其与 KOA 的严重程度并不相关。但在膝骨性关节炎阶梯化治疗中仍应重视此问题，以避免由于韧带稳定性不良而产生的并发症。

Abstract:

[Objective] To evaluate the imaging measurement, pathological mechanism and clinical significance of coronal tibiofemoral subluxation (CTFS) . [Methods] As PubMed, Embase, Cochrane Library, Web of Science and other international medical databases were searched with "tibiofemoral", "tibial and femoral", "instability", "subluxation", "dislocation" and "CTFS" as the key words, the related litera- tures were selected manually according to the inclusion criteria. [Results] A total of 18 articles were included, of which 16 reported imaging measurement methods, 6 reported mechanism and risk factors, and 10 reported clinical issues. At present, there is no unified standard for Xray measurement of CTFS, while there are few studies on the mechanism of CTFS still with controversies. Currently, the accepted theory is that the lateral ligament structure of the knee joint is relatively relaxed. CTFS is a common radiographic manifestation of KOA, but is not of value in determining the severity of KOA. In terms of clinical symptoms, current research is still controversial. [Conclusion] The mainstream view of CTFS is that it is not related to the severity of KOA. However, attention should be paid to this problem in the stepwise treatment of knee osteoarthritis to avoid complications due to poor ligament stability.