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- 您请求的操作仅限于组中的用户:流行病学/病因学== PFPS可由髌骨外伤引起,但更常见的是几个因素(多因素原因)的结合:髌股关节的过度使用和负荷,解剖或生物力学异常,肌肉无力,不平衡或功能障碍。由于上述几个因素,PFPS更有可能恶化并对治疗产生抗药性。
** 髌骨过度负荷和异常跟踪是PFP症状的主要原因Yang JS, Fredericson M, Choi JH。[https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239907直立负重条件下髌骨股骨疼痛综合征对髌骨股骨关节运动学的影响]。Plos one。2020年9月30日;15(9):e0239907。导致PFPS的主要原因之一是髌骨的定位和对准。(图1)当髌骨有不同的方向时,它可能会更多地向相髌骨(股骨)的一侧滑动,从而导致该部分股骨的过度使用/过载(超压),从而导致疼痛、不适或刺激。有不同的原因可以引发这种偏差。每位患者的髌骨方向不同; it can also be different from the left to right knee in the same individual and can be a result of anatomical malalignments. A little deviation of the patella can cause muscular imbalances, biomechanical abnormalities … which can possibly result in PFPS. Conversely, muscular imbalances or biomechanical abnormality can cause a patellar deviation and also provoke PFPS. For example: When the Vastus Medialis Obliquus isn’t strong enough, the Vastus Lateralis can exert a higher force and can cause a lateral glide, lateral tilt or lateral rotation of the patella which can cause an overuse of the lateral side of the facies patellaris and result in pain or discomfort. The opposite is possible but a medial glide, tilt or rotation is rare. Another structure that can cause a patellar deviation is the lateral retinaculum. PFPS can also be due to knee hyperextension, lateral tibial torsion, genu valgum or varus, increased Q-angle, tightness in the iliotibial band, hamstrings or gastrocnemius. (see table 1) Sometimes the pain and discomfort is localized in the knee, but the source of the problem is somewhere else. Pes planus (pronation) or Pes Cavus (supination) can provoke PFPS. Foot pronation (which is more common with PFPS) causes a compensatory internal rotation of the tibia or femur that upsets the patellofemoral mechanism. Foot supination provides less cushioning for the leg when it strikes the ground so more stress is placed on the patellofemoral mechanism. The hip kinematics can also influence the knee and provoke PFPS. A study has shown that patients with PFPS displayed weaker hip abductor muscles that were associated with an increase in hip adduction during running. Table 1 {| style="width: 675px; height: 167px" border="1" cellspacing="1" cellpadding="1" width="675" |- | '''Muscular etiologies of PFPS''' | |- | ''Etiology'' | Pathophysiology |- | Weakness in the quadriceps | It may adversely affect the PF mechanism. Strengthening is often recommended. |- | Weakness in the medial quadriceps | It allows the patella to track too far laterally. Strengthening of the VMO is often recommended. |- | Tight iliotibial band | It places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the PF mechanism. This can lead to excessive lateral tracking of the patella. |- | Tight hamstrings muscles | It places more posterior force on the knee, causing pressure between the patella and the femur to increase. |- | Weakness of tightness in the hip muscles | Dysfunction of the hip external rotators results in compensatory foot pronation. |- | Tight calf muscles | It can lead to compensatory foot pronation and can increase the posterior force on the knee. |}