An Overview of Patellar Pain-Current concepts Review

膝蓋痛面面觀－最新醫療新知回顧

林永福(Yeong-Fwu Lin)

《北市醫學雜誌》 1卷1期 (2004/01) Pp. 6-16

https://doi.org/10.6200/TCMJ.2004.1.1.04

摘要

目的：回顧當今有關髕骨疼痛之最新觀念，包括概念由來、各種觀念之演變、如何評估鑑別，以至於如何治療等。方法：透過文獻回顧及作者近三十年浸潤於斯之臨床經驗，試著將髕骨疼痛之種種知識做有系統及深入淺出的介紹。結果：髕骨疼痛主要多為髕骨與股骨間疼痛症候群（Patellofemoral pain syndrome，PFPS）。而股骨間疼痛症候群依發病原因得概括為下肢旋轉異常或髕骨本身排列異常、肌力失衡，及過度使用三大類。以上三者有關之診斷及治療考量分別加以扼要剖析。結論：髕骨痛可以非單一原因所致。髕骨排列異常不盡然引發症狀。髕骨排列異常往往須另有誘因以呈現髕骨疼痛。當下，髕骨排列不正，周詳診斷少而過度手術者眾。顯然，精確診斷與各專業齊心投入乃邁向成功處置之不二法門。手術之考量必須有一套標準的篩選程序，特別是競相從事的髕骨側韌帶放鬆術。基於長期下影響髕骨側韌帶放鬆術成效因子（prognosticators）之關注，作者認為一個穩定的髕骨、髕骨具有明確的Sage sign、髕骨與髕骨窩之間充分吻合、理想的術後運動方式，以及病人確實投入於術後運動等情境存在皆有助於達成較好的手術結果。面對髕骨排列不正所致之髕骨痛個案，一旦保守療法失敗，只有Sage sign明顯，即可逕行訴諸髕骨側韌帶放鬆術；對於Sage sign不明顯之個案，如果髕骨與髕骨窩之間適當吻合，亦不用猶豫地施以髕骨側韌帶放鬆術；如果Sage sign不明顯、髕骨與髕骨窩之間也不吻合，再加上髕骨又鬆動不穩，則一定要尋求替代之手術方式，即使髕骨並非鬆動不穩，也不必汲汲於髕骨側韌帶放鬆術，這時候，配合其他情境，應另有選擇。以上為作者所建議之實用的個案篩選程序。

關鍵字

膝蓋痛 ； 髕骨痛 ； 髕骨軟骨軟化症 ； 髕股骨間疼痛症候群 ； 髕骨側韌帶放鬆術

並列摘要

Objective: The goal of this article is to overview the current concepts of patellar pain, including history, evaluation, and treatment options for patients with patellar pain. Methods: Based on literature review and clinical experience, the concepts of patellar pain is systemically discussed. Results: Patellar pains are dominated by patellofemoral pain syndrome (PFPS) which consists of 3 major contributing factors: 1. malignment of the lower extremity and／or the patella; 2. muscular imbalance of the lower extremity; and 3. overactivity. The diagnosis and treatments have been discussed. Conclusions: Patellar pain could have more than one cause and patellar malignment does not necessarily result in symptoms. A trigger is required for the symptom to come. Patellar malignment is usually under-diagnosed and over-operated. A exact diagnosis and multidisciplinary cooperation are necessary to successful management. A protocol for lateral release is developed. Based on a long term study of prognosticators for isolated lateral release, those with a stable patella. Definite sage sign, well-conformed patellofemoral joint, right exercise mode, and adequacy in doing exercise are good prognosticators, and vice versa. As evidence-based the author has created a practical algorithm for better case selection. If sage sign is definite, lateral release is proceeded without looking back. For those with negative Sage sign but well-conformed patellofemoral joint, lateral release is proceeded, too. For those with negative Sage sign, poorly conformed patellofemoral joint, and non-laxed patella lateral release is proceeded with hesitatation, and maybe some alternate is in favor. For those with negative Sage sign, poorly conformed patellofemoral joint, and laxed patella lateral release has no place in treating patellar malignment. As thus the author does not perform lateral release for all malignments and a more complex operation specific to pathology is considered for those lateral release is not in favor.

並列關鍵字

patellar pain ； patellofemoral joint ； patellofemoral pain syndrome ； chondromalacia patellae