WU Jiang yan,HE Rong guo,MEI Hai bo,et al.Combination of soft tissues procedures for habitual patellar dislocation in children and evaluation of operative outcome.[J].Journal of Clinical Pediatric Surgery,2010,9(06):417.
软组织联合手术治疗儿童习惯性髌骨脱位与疗效评价
- Title:
- Combination of soft tissues procedures for habitual patellar dislocation in children and evaluation of operative outcome.
- Keywords:
- children; habitual dislocation; patella; soft tissues procedure
- 文献标志码:
- A
- 摘要:
- 目的介绍软组织联合手术治疗本病的技术操作，评价和分析手术结果。方法基于本病的主要解剖学异常，选择髌外侧软组织松解、股内侧肌斜头前置和髌腱外侧半止点内移等软组织联合的手术方式，治疗9例(11膝)儿童习惯性髌骨脱位，并从临床与X线检查两方面评价手术结果；患者平均年龄9.1（6.2～14.1）岁；男6例，女3例；双侧2例，单侧7例；除1例12.4岁女性儿童为Down综合征外，其余8例为单纯性或特发性习惯性髌骨脱位。结果术后平均随访时间3年7个月（2～6.5年）。8例10膝获得稳定复位，9膝关节平均伸屈活动范围110°（95°～130°）。正侧位及轴位X线片显示股骨外髁发育不良、股骨滑车切迹宽浅及膝外翻均获得明显改善；1例于术后1年发生再脱位，再次采取髌腱内移手术使髌股关节获得稳定；1例双侧髌骨脱位因康复训练不足于术后6个月发生膝关节僵硬，需再次手术进行软组织松解。结论外侧软组织松解、股内侧肌前置和髌腱外侧半内移联合手术，不仅能够实现髌股关节的稳定，股骨外髁发育不良和滑车切迹宽浅也获得明显改善。适应于治疗儿童习惯性髌骨脱位。
- Abstract:
- ObjectiveTo describe the surgical technique, and evaluate and analyze the clinical outcomes of patients who underwent combination of soft tissue procedures.MethodsEleven knees (6 boy and 3 girl) treated for habitual patellar dislocation were evaluated clinically and radiographically and operatively treated by combinations of extensive lateral release ,advance of the vastus medialis oblique and RouxGoldthwait procedure. A mean age at time of operation was 9,1 years (range 6.2～14.1 years).ResultBesides one girl with Down syndrome who had bilateral dislocation of patella, The eight patients（nine knee）were idiopathic habitual patellar dislocation. Patients were reviewed at an average followup of 3.7years (range 2～6.5 years). None showed signs of recurrence of the dislocation but 14 years old patient had recurrent dislocation of left knee after ten mouths of operation, of which had been successfully treated with medial displacement of whole tibial tubercle. The mean range of motion of knee was 110°（range 95°～130°）in nine knee (8 patients).The other patient with bilateral dislocation of patella had stiff of bilateral knee who required soft tissue release after six months of operation. The radiographic evaluation including anterioposterior view,lateral view and axial view showed improvement of dysplasia of lateral condyle and dysplastic trochlea.ConclusionThe majority of patients have stable patellofemoral joint and the dysphasia of lateral condoyle and shallow trochlea have been obvious remolded, therefore the combination of soft tissues procedures is suitable to treat habitual patellar dislocation in younger children.
参考文献/References:
1Joo SY,Park KB,Kim BR.J The ’fourinone’ procedure for habitual dislocation of the patella in children: early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove\[J\].J Bone Joint Surg Br,2007,89:1645—1649.2Elgafy H,ElKawy S,Elsafy M,Ebraheim NA.Internal torsion of the distal femur as a cause of habitual dislocation of the patella: a case report and a review of causes of patellar dislocation\[J\].Am J Orthop (Belle Mead NJ),2005,34(5):246—248. 3Gerbino PG,Zurakowski D,Soto R,et al.LongTerm Functional Outcome after lateral Patellar Retinacular Release in Adolescents: An Observational Cohort Study With Minimum 5Year FollowUp\[J\].J Pediatr Orthop,2008,28:118—123.4Bettuzzi C,Lampasi M,Magnani M,Donzelli O.Surgical treatment of patellar dislocation in children with Down syndrome: a 3to 11year followup study\[J\].Knee Surg Sports Traumatol Arthrosc,2009,17:334—340.5Haim A,Yaniv M,Dekel S,et al.Patellofemoral Pain Syndrome Validity of Clinical and Radiological Features\[J\].Clin Orthop,2006,451, 223—228.6Salzmann GM, Weber TS,Spang JT,et al.Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia\[J\].Arch Orthop Trauma Surg,2010,130:335—340.7Marcacci M,Zaffagnini S,Lo Presti. Treatment of chronic patellar dislocation with a modified ElmslieTrillat procedure\[J\].Arch Orthop Trauma Surg,2004,124:250—257.8Herring JA.Tachdjian’s Pediatric Orthopaedics,Fourth edition,Philadelphia:W.B.Saunsers Company,2008,954.9Gao GX,Lee EH, Bose K.Surgical management of congenital and habitual dislocation of the patella\[J\].J Pediatr Orthop,1990,10:255—260. 10Rick A Raimondo,Christopher S Ahmad,Leendert Blankevoort,et al. Patellar stabilization: A quantitative evaluation of the vastus medialis obliquus muscle\[J\].Orthopedics,1998,21(7):791—795.11Krause F,Kolling C,Brantschen R,et al.Mittelfristige Er gebnisse der VastusmedialisobliquusPlastik bei lateraler Patellaluxa tion\[J\].Orthopade,2006,35:94—101.12Utting MR,Mulford JS,J Eldridge JD.A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability\[J\].Journal of Bone and Joint Surgery,2008,90(2):180.13Knoch FV,Bhm T,Bürgi ML,et al.Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia\[J\].J Bone Joint Surg,2006,88:1331—1335.