习惯性髌骨脱位的手术治疗

习惯性髌骨脱位尚无有效的治疗方法，病程越长，引起的损害就越严重，本文结合相关文献对习惯性髌骨脱位的手术治疗综述如下。     

习惯性髌骨脱位合并髌骨骨软骨骨折的手术治疗

[目的]探讨习惯性髌骨脱位合并髌骨骨软骨骨折的手术治疗方法。[方法]自2000年7月-2004年12月对18例习惯性髌骨脱位合并髌骨骨软骨骨折病人行手术治疗。[结果]本组18例按Insall标准评价疗效，优良率88．9％，术后无髌骨再脱位和半脱位，无严重并发症发生。[结论]采用外侧松解、内侧紧缩和股内侧肌止点外下移、髌韧带外侧半内移的综合手术治疗习惯性髌骨脱位，根据骨块的大小及损伤的时间处理髌骨骨软骨骨折，效果满意。     

手术治疗儿童习惯性髌骨脱位

习惯性髌骨脱位是髌股关节不稳定中表现形式最严重的一种,是由多种复杂病因所致的一种发育性畸形,好发于儿童。1998年8月-2005年10月,我科采取综合软组织手术治疗14例儿童习惯性髌骨脱位,疗效满意。     

家族性习惯性髌骨脱位

习惯性髌骨脱位临床比较常见，其病因多种多样，多与外伤及骨关节发育异常有关，但未见家族性临床报道，本科近期收治1例具有家族史的习惯性髌骨脱位，现报告如下：     

习惯性髌骨脱位的治疗进展

习惯性髌骨脱位常在膝关节发育不良的基础上发生。其局部表现为膝内侧软组织松弛薄弱,外侧软组织挛缩,股骨外髁发育差,移动性髌骨,久而久之发生退变性骨关节炎影响功能。这种疾病可造成长期的诸如髌骨周围钝痛,膝关节乏力,支撑不住“打软腿”、突然活动不灵和摩擦等症状,严重影     

双侧髌骨习惯性脱位1例

患者 ,女 ,12岁 ,汉族 ,未婚 ,陕西省凤县平木镇烧锅庄村四组。学生。因“双侧膝关节无力及活动障碍 2 0天”入院。家人代述 2 0天前患者摔伤后出现双膝部疼痛 ,有“打软腿”现象 ,走路时常无缘无故摔倒 ,未在意 ,继而发现患儿在下蹲时 ,膝关节屈曲接近 90°时突然无力 ,起立时须用双手撑地 ,否则不能起立。患儿自诉上、下楼梯和下蹲时双膝关节疼痛 ,平时感双下肢乏力 ,双侧膝关节活动不灵活 ,活动时双侧膝关节有磨擦感。未引起家人重视 ,也未做任何治疗。近日发现上述症状频繁发作 ,前来我院就诊 ,门诊诊断为“双侧髌骨习惯性脱位”收住我…     

儿童习惯性髌骨脱位的手术治疗

目的 探讨治疗儿童习惯性髌骨脱位的手术方法。方法 习惯性髌骨脱位患者３６例,平均年龄９．１岁;采用复合性软组织手术的方法对其中４５个髌骨脱位进行治疗;手术方法包括膝外侧软组织广泛松解,股外侧肌止点上移,膝内仙软组织紧缩,股内侧肌移位和半侧髌腱内移术;平均随访时间４年４个月。结果 ２８例患者获得满意的功能和稳定的膝关节。运动能力明显提高;７例随访时间４年４个月。结果 ２８例患者获得满意的功能和稳定的膝关节。运动能力明显提高;７例患者虽然对膝关节功能很满意,但在进行剧烈体育运动时手术侧膝关节有力弱感,与术前相比改善不明显;１例患者术后发生再脱位,所有患者均无伤口感染和膝关节活动受限。结论 采用复合性软组织手术的方法治疗儿童习惯性髌骨脱位患者,不损伤骨骺,易于操作,可取得明显疗效。     

改良髌骨半脱位的治疗方法

髌骨半脱位,临床上较常见,治疗方法较多,效果不尽人意。１９７８年始应用带状缝匠肌,游离下１／３段,其止点不切断,移至髌骨前固定,增建一个动力性髌韧带和增加股内侧肌肌力,加强髌骨向内的可变拉应力,使Ｑ角变小,恢复髌骨的动力性稳定,防止髌骨半脱位,收到满...     

儿童习惯性髌骨脱位的诊治体会

目的探讨儿童习惯性髌骨脱位的诊断和治疗。方法儿童习惯性髌骨脱位患儿21例,全部采用膝关节外侧软组织松解、内侧关节囊紧缩、半侧髌韧带内移或胫骨粗隆内移术等联合手术。结果本组21例患儿,经6个月～3年随访,检查膝关节功能,屈曲膝关节90°,髌骨不再脱位,疗效均较满意。结论采用膝关节外侧软组织松解、内侧关节囊紧缩、半侧髌韧带内移或胫骨粗隆内移术等联合手术治疗儿童习惯性髌骨脱位,疗效确定,且年龄越小,手术效果越好。     

Neglected locked vertical patellar dislocation

Patellar dislocations occurring about the vertical and horizontal axis are rare and irreducible. The neglected patellar dislocation is still rarer. We describe the clinical presentation and management of a case of neglected vertical patellar dislocation in a 6 year-old boy who sustained an external rotational strain with a laterally directed force to his knee. Initially the diagnosis was missed and 2 months later open reduction was done. The increased tension generated by the rotation of the lateral extensor retinaculum kept the patella locked in the lateral gutter even with the knee in full extension. Traumatic patellar dislocation with rotation around a vertical axis has been described earlier, but no such neglected case has been reported to the best of our knowledge.     

Computational approach to correcting joint instability in patients with recurrent patellar dislocation

Patellar dislocation is a debilitating injury common in active adolescents and young adults. Conservative treatment after initial dislocation is often recommended, but almost half of these patients continue to suffer from recurrent dislocation. The objective of this study was to compare preoperative patellofemoral joint stability with stability after a series of simulated procedures, including restorative surgery to correct to pre-injury state, generic tibial tubercle osteotomy, patient-specific reconstructive surgery to correct anatomic abnormality, less invasive patient-specific surgery, and equivalent healthy controls. Three-dimensional, subject-specific finite element models of the patellofemoral joint were developed for 28 patients with recurrent patellar dislocation. A 50 N lateral load was applied to the patella to assess the lateral stability of the patellofemoral joint at 10° intervals from 0° to 40° flexion. Medial patellofemoral ligament reconstruction, along with reconstructive procedures to correct anatomic abnormality were simulated. Of all the simulations performed, the healthy equivalent control models showed the least patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament restraining load during lateral loading tests. Isolated restorative medial patellofemoral ligament reconstruction was the surgery that resulted in the most patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament reaction force across all flexion angles. Patient-specific reconstruction to correct anatomic abnormality was the only surgical group to have non-significantly different results compared with the healthy equivalent control group across all joint stability metrics evaluated. Statement of clinical significance: This study suggests patient-specific reconstructive surgery that corrects underlying anatomic abnormalities best reproduces the joint stability of an equivalent healthy control when compared with the pre-injury state, generic tibial tubercle osteotomy, and less invasive patient-specific surgery. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:768-776, 2020     

Computational analysis of factors contributing to patellar dislocation

Treatment for an initial incidence of patellar dislocation is usually conservative management; however, almost half of patients experience a subsequent, or multiple, dislocation(s). Patients often undergo multiple procedures which fail to treat the underlying anatomic abnormalities. The objective of this study was to evaluate interactions between key predisposing anatomic factors to patellar dislocation and identify combinations of abnormal factors which increase the risk of recurrent lateral dislocation. Four factors associated with lateral patellar dislocation were identified (sulcus angle, Insall‐Salvati ratio, tibial tubercle‐trochlear groove distance, and femoral anteversion). A finite element model of the patellofemoral joint was developed and parameterized so that a value for each factor could be applied and the model geometry/alignment would be modified accordingly. 100 combinations of the four factors were generated in separate computational simulations and resulting kinematics and forces of the patellofemoral joint were recorded. Sulcus angle was the most impactful factor on constraint. Multiple abnormal factors were generally required to produce the extremes of patellar alignment observed in this analysis. Understanding the underlying anatomic factors, and their effect on joint mechanics, for patients with recurrent lateral patellar dislocation will aid in determining optimal treatment pathways on a patient‐specific basis. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:444–453, 2016.     

经骨缝合手术治疗急性髌骨脱位合并髌骨软骨Peeloff损伤早期疗效观察

目的评价经骨缝合手术治疗急性髌骨脱位合并髌骨软骨骨折(Peeloff损伤)的早期临床疗效。方法回顾性分析自2019-05—2020-03诊治的15例急性髌骨脱位合并髌骨软骨Peeloff损伤,膝关节镜检查并确诊髌骨软骨缺损,关节腔内找到与缺损区域吻合的游离软骨片,关节镜下或内侧小切口取出游离软骨片;再作髌内侧切口,将游离软骨片复位并在其边缘选取4个合适进针点,用带孔克氏针在髌骨主体上从内向外垂直钻孔,每两孔之间导入可吸收缝线,经孔道将克氏针抽出时带出缝线并打结。结果 15例均获得随访,随访时间平均8(3~13)个月。术后3个月MRI显示所有患者髌骨关节面软骨骨折均愈合。2例出现早期髌股关节疼痛(1例VAS评分为4分,1例VAS评分为5分),经康复治疗后好转,其余13例疼痛VAS评分平均1.8(1~3)分。末次随访时Tegner运动评级:3级5例,4级9例,5级1例。末次随访时膝关节功能Lysholm评分80~96(88.9±4.7)分,其中优6例,良7例。结论关节镜下探查可确诊急性髌骨脱位合并的髌骨软骨Peeloff损伤,采用可吸收缝线经骨缝合固定髌骨关节面软骨片无需特殊内固定器械及二次手术取出,既能实现软骨稳定固定、正常愈合,又能保证膝关节功能良好恢复。     

Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

We report a case of recurrent patellar dislocation with high-grade trochlear dysplasia which persisted despite two previous operations. We did a Dejour''s sulcus deepening trochleoplasty, medial patellofemoral ligament reconstruction, and lateral retinacular release. Trochleoplasty and medial patellofemoral ligament reconstruction is required in patients with high grade trochlear dysplasia.     

关节镜下自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位

目的探讨关节镜下采用自体腘绳肌腱重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 2005年1月-2010年1月,对22例(22膝)复发性髌骨脱位患者采用关节镜下外侧支持带松解,取自体腘绳肌腱重建内侧髌股韧带治疗。男5例,女17例;年龄15～19岁,平均17.3岁。髌骨脱位3～8次,平均4次。主要临床症状为患膝关节疼痛、肿胀、无力,活动受限。髌骨倾斜试验、恐惧试验、内侧髌股韧带止点处压痛、髌骨向外推移时恐惧征均呈阳性。根据国际膝关节文献委员会(IKDC)评分标准,膝关节功能主观评分为(36.7±4.7)分,Lysholm评分为(69.3±3.8)分。X线片示患者髌骨向外倾斜。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间18～49个月,平均34个月。术后患者关节疼痛、肿胀、无力等症状较术前明显改善。随访期间患者髌骨脱位无复发。末次随访时,IKDC膝关节功能主观评分为(92.4±5.3)分,Lysholm评分为(91.7±5.2)分,与术前比较差异均有统计学意义(P<0.05)。结论关节镜下取自体腘绳肌腱重建内侧髌股韧带可明显改善髌骨稳定性,是治疗复发性髌骨脱位的有效方法之一。     

内侧髌股韧带重建治疗复发性髌骨脱位

目的介绍采用内侧髌股韧带(medial patellofemoral ligament,MPFL)重建治疗复发性髌骨脱位的手术技术和效果。方法 2005年6月-2007年9月,采用MPFL重建治疗复发性髌骨脱位29例。男6例,女23例;年龄13～45岁,平均20.3岁。髌骨脱位2～10次。末次髌骨脱位至手术时间为1～144个月,平均43.9个月。术前CT检查测量胫骨结节-股骨滑车间距(tibial tuberosity-trochlear groove distance,TT-TG);并行Kujala、Lysholm和Tegner评分,分别为(72.03±17.38)、(72.65±14.70)、(5.25±1.83)分。手术采用同种异体肌腱作为移植物,在股骨侧使用骨隧道技术,可吸收挤压螺钉固定;在髌骨内侧缘制作双L形隧道,调节移植物张力后,缝合固定移植物的游离端。同时行关节镜检查、游离体取出和髌外侧支持带松解。对于TT-TG>20 mm的16例患者,同时行胫骨结节内移截骨。结果 27例获随访,随访时间40～67个月,平均45.5个月。患者术后均无髌骨再脱位,也无髌骨错动或半脱位。0°位和屈膝30°位髌骨外推试验和外推恐惧试验均为阴性。术后1年患者膝关节屈伸活动度均恢复正常,能够完全下蹲。末次随访时Kujala评分、Lysholm评分分别为(94.10±7.59)、(95.44±6.25)分,与术前比较差异均有统计学意义(P<0.05);Tegner评分为(4.33±1.00)分,与术前比较差异无统计学意义(t=1.302,P=0.213)。术前TT-TG>20 mm的患者末次随访时TT-TG为(16.88±5.92)mm,与术前(23.38±3.70)mm比较差异有统计学意义(t=2.822,P=0.026)。结论 MPFL重建治疗复发性髌骨脱位能够明显改善髌骨稳定性,且术后膝关节功能评分和运动等级评分均较术前明显改善。     

Medium-term results of the operative treatment of patellar dislocation by the Insall method of proximal realignment

Summary Between 1984 and 1991, 57 patients with diagnosis of an acute or recurrent patellar dislocation were treated operatively using proximal realignment with vastus medialis transfer and lateral release (Insall operation). A total of 45 patients (15 with acute and 30 with recurrent patellar dislocation) were reviewed at an average follow-up of 6.5 years (2–9.6 years). The average age at injury was 21.5 years, with a predominance of female patients. Follow-up examination included routine knee examination, clinical review using the modified knee scoring scale of Larsen and Lauridsen, sports activity level and subjective satisfaction. Radiographics from 27 patients (60 %) were evaluated. One patient from each group suffered recurrence of patellar dislocation. All patients had stable knee joints and a full range of motion. There was no statistical difference in the pre- and postoperative sports activity level in both groups. Three patients (19.9 %) with acute patellar dislocation and seven patients (23.3 %) with recurrent patella dislocation had excellent results using the Larsen and Lauridsen score scale. Ten patients (66.6 %) with acute and 12 (39.9 %) with recurrent dislocation had good results. One patient with recurrent patellar dislocation had a fair result. Subjective evaluation revealed the operative result in 93 % of cases as very good, good or satisfactory. Patellofemoral osteoarthritis was seen in 11 (40.7 %) of 27 patients. Our results show good clinical results for the treatment of acute patellar dislocation in young, active patients with the proximal realignment procedure. The recurrence rate of patellar dislocation can be reduced for acute and recurrent patellar dislocation. Subjective satisfaction with this procedure is rated very good.      

复合软组织手术对儿童习惯性髌骨脱位髌股关节适应性的影响

目的 研究复合软组织手术治疗不同年龄段儿童习惯性髌骨脱位后,髌股关节适应性的变化情况.方法 回顾性分析2000至2007年收治的习惯性髌骨脱位患儿73例.男24例,女49例;平均年龄7.1岁(3～15岁);单侧47例,双侧26例.按照年龄分为A、B两组:A组年龄3～8岁(包括8岁),24例(30膝);B组年龄8～15岁,49例(69膝).复合软组织手术包括膝关节外侧充分松解、内侧紧缩、髌腱半腱上点移位(Roux-Goldthwait手术)和股内侧肌止点下移术.术前及随访中分别行髌骨轴位和侧位X线检查,测量股骨滑车角、髌骨高度、髌骨-滑车适配角及髌骨倾斜角(Laurin角)的变化情况,以评价髌股关节适应性.结果 73例患儿均获随访,平均随访38个月(25～98个月).末次随访时髌骨脱位均无复发,其中2例发生髌骨内侧脱位.股骨滑车角:A组由术前的150.1°±5.1°改善为144.3°±6.0°,手术前后差异有统计学意义(P＜0.05);B组手术前后差异无统计学意义(P＞0.05).其余测量指标在两组均无显著变化.结论 复合软组织手术对儿童习惯性髌骨脱位髌股关节的塑型有影响,对于手术年龄在8岁以下儿童可以明显促进股骨髁的发育,降低股骨滑车角,改善髌股关节适应性;8岁以上儿童在随访期内股骨滑车角的变化不显著,髌股关节适应性改变不明显.