关节镜辅助下三联法治疗儿童髌骨固定型脱位的疗效观察

doi:10.13418/j.issn.1001-165x.2018.05.018

摘要/Abstract

摘要：

目的　探讨关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定型脱位临床疗效。方法　回顾分析2014年1月至2017年1月收治10例12膝儿童髌骨固定型脱患者资料，男6例8膝，女4例4膝；年龄为4~9岁，平均6.6岁。所有患者均采用关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定型脱位，术后随访根据髌骨稳定度及Kujala 评分评定膝关节功能恢复情况。结果　10例儿童术后获得6~18个月（平均随访12个月）随访。所有儿童末次随访髌骨稳定度满意，Kujala 评分由术前的（42.12±14.37）分增加到随访时的（95.68±9.42）分，差异有统计学意义（P＜0.05）。结论　关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定性脱位临床疗效满意，可以有效增加髌骨稳定性，改善膝关节功能，对骨骺不造成损害，是一种有效的治疗儿童髌骨固定型脱位的手术方法。

关键词: 儿童, 　髌骨不稳, 　规避骺板, 　固定型脱位

Abstract:

Objective　To investigate the clinical effect of arthroscopy assisted reconstruction of medial patellofemoral ligament (MPFL), lateral retinaculum with Y-shaped release, and femoral medial muscle formation on the treatment of patellar fixation dislocation.　Methods　10 patients with 12 knees were treated with patellar fixation dislocation from January 2014 to January 2017 were retrospectively reviewed, including 6 males with 8 knees and 4 females with 4 knees. The age was from 4 to 9 years (mean 6.6 years). All patients underwent arthroscopy assisted reconstruction of the medial patellofemoral ligament (MPFL) with allogeneic ligaments, Y-shaped dissection of the lateral retinaculum, combined with femoral medial muscle formation in the treatment of patellar fixation dislocation. Postoperative follow-up was performed to assess knee functional recovery based on patellar stability and Kujala score. Degree and Kujala score were applied to assess functional recovery of knee joint.　Results　10 patients were followed up for 6 to 18 months (mean follow - up of 12 months). The Kujala score increased from (42.12±14.37) to (95.68±9.42), the difference was statistically significant (P<0.05).　Conclusion　The use of allograft ligament in the reconstruction of medial patellofemoral ligament (MPFL), lateral retinaculum with Y-shaped release, combined with femoral medial muscle formation treatment of children with patellar fixation dislocation clinical efficacy is satisfactory, and can effectively improve patellar stability, the knee function, and the epiphyseal is not damaged, which is an effective treatment of children with patellar fixation dislocation of the surgical method.

Key words: Child, Patella instability, 　Avoid the damage to the epiphyseal plate, 　Patellar fixation dislocation

宋伟毅,吴宇峰,林晓航,黄子奇. 关节镜辅助下三联法治疗儿童髌骨固定型脱位的疗效观察[J]. 中国临床解剖学杂志, 2018, 36(5): 574-577.

SONG Wei-yi，WU Yu-feng，LIN Xiao-hang，HUANG Zi-qi. The clinical effect of arthroscopic assisted reconstruction with three in one methodology on the treatment of patellar fixation dislocation[J]. Chinese Journal Of Clinical Anatomy, 2018, 36(5): 574-577.

参考文献

[1] 柴卫兵,朱天岳, 卢宏章.髌骨半脱位的病因探讨和疗效观察(附 61例报告).北京医学, 2003, 25(5):306 -308
[2] Fithian DC，Paxton EW，Cohen AB．Indications in the treatment of patellar instability[J]．J Knee Surg 2004，17(1)：47-56．
[3] Deie M，0chi M，sumen Y，et al．Reconstruction of the medialpatell of emoraligent for tlle treatment of habitual or recurrent dis—location of the patella in children[J]．J Bone Joint surg Br，2003，85(6)：887-890．
[4] 赵洪波，周宏艳，陈德生，等. 青少年急性髌骨脱位合并骨软骨骨折的治疗[J]. 中华小儿外科杂志，2014，35(1)：20-23.
[5] 高玉龙，陈丽，乔建民，等．屈膝30°体位CT 扫描对青少年习惯性髌骨脱位的诊断价值[J]．中国骨与关节损伤杂志, 2017，32(3)：327-328．
[6] Kujala UM，Jaakkola LH，Koskinen SK，et al. Scoring of patellofemoral disorders[J]．Arthroscopy, 1993, 9:159-163.
[7] Stanisavljevic S, Zememnick G, Miller D. Congenital, irreducible, permanent lateral dislocation of the patella[J]. Clin Orthop Relat Res, 1976,(116):190-199.
[8] Gerbino PG，Zurakowski D，Soto R，et al. Long-term functional outcome after lateral patellar retinacular re-lease in adolescents：a observational cohort study with least 5-year follow-up [J] .J Pediatr Orthop，2008, 28(1)：118-123.
[9] Conn H. A new method of operative reduction for congenital luxation of the patella[J].J Bone Joint Surg, 1925,7:370.
[10]Ghanem I, Wattincourt L, Seringe R. Congenital dislocation of the patella[J]. J Pediatr Orthop, 2000, 20(6): 817-822
[11] Goorens CK，Robijn H，Hendrickx B，et al. Reconstruction of the medial patellofemoral ligament for patellar instability using a autologous gracilis tendon graft[J]. Acta Orthop Belg, 2010, 76(3)：398-402.
[12]Zhao J, Huang FX, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty [J]. Am J Sports Med, 2012, 40 (1): 123-132.
[13] Yercan HS, Erkan S, Okcu G, et al. A novel technique for Reconstruction of the medial patellofemoral ligament in skeletally immature patients [J]. Arch Orthop Trauma Surg, 2011, 131 (8): 1059-1065.
[14] Kumahashi N, Kuwata S, Tadenuma T, et al. A "sand-wich" method of reconstruction of the medial patellofemoral ligament using a Titanium interference screw for patellar instability in skeletally immature patients [J]. Arch Orthop Trauma Surg, 2012, 132 (8): 1077-1083.
[15] Wang F, Kang HJ, Chen BC, et al. Combination of medial Patellofemoral ligament reconstruction with vastus media-lis advancement for chronic patellar dislocation [J]. ChinMed J (Engl), 2010, 123 (21): 3024-3029.
[16] Oliva F, Ronga M, Longo UG, et al. The 3-in-1 procedure For recurrent dislocation of the patella in skeletally immature children and adolescents [J]. Am J Sports Med, 2009, 37 (9): 1814-1820.
[17] Joo SY, Park KB, Kim BR, et al. The 'four-in-one' procedure for habitual dislocation of the patella in children: early results in patients with severe generalized ligamentous laxity and aplasis of the trochlear groove [J]. J Bone Joint Surg Br, 2007, 89 (12): 1645-1649.
[18]张亮，高建明，项杨，等. 大收肌腱转位重建内侧髌股韧带的应用解剖[J]. 中国临床解剖学杂志, 2017, 35(3)：241-244.
[19]Gerbino PG，Zurakowski D，Soto R，et al. Long-term functional outcome after lateral patellar retinacular release in adolescents：an observational cohort study with least minimum 5-year follow-up [J]. Pediatr Orthop，2008, 28：118-123.
[20]Lattermann C, Toth J, Bach BR Jr, et al. The role of lateral retinacular release in the treatment of patellar instability [J]. Sports Med Arthrosc, 2007, 15(2): 57 -60.
[21]Fulkerson JP. Operative management of patellofemoral pain[J]. Ann Chir Gynecol, 1991, 80(2):224-229.
[22] Hauser ED. Total tendon transplant for slipping patella:a new operation for recurrent dislocation of the patella.1938[J]. Clin Orthop Relat Res.2006, 452:7-16.
[23]陈游，王志杰，黄国良，等. 内侧髌股带韧带重建术治疗复发性髌骨脱位的疗效研究[J/ CD]. 中华关节外科杂志电子版，2013,7：3-6.
[24]纪刚，王飞，董江涛，等.双束解剖重建内侧髌股韧带联合胫骨结节转移术治疗复发性髌骨脱位的临床研究[J / CD].中华关节外科杂志电子版，2013, 7：7-11.
[25]吕学敏，闫桂森，郭源. 复合软组织手术对儿童习惯性脱位髌股关节适应性的影响[J]. 中华骨科杂志，2010, 30(9):870-875.