不同软组织移植治疗儿童复发性髌骨脱位的比较

背景：成人复发性髌骨脱位由于不必考虑损伤骨骺的问题，多数采用骨移植，但在儿童复发性髌骨脱位采用骨移植并不适宜，多数学者采用软组织移植治疗。目的：回顾性评估22例骨骺未闭儿童复发性髌骨脱位患者采用软组织移植治疗的临床效果。方法：回顾性分析2006年5月至2009年4月上海长征医院关节外科采用软组织移植治疗儿童复发性髌骨脱位患者22例共29膝，分别在移植后3周，6周，3个月，1年和此后每年对患者进行随访，评估髌骨稳定性、主观症状以及患膝康复情况。结果与结论：22例患者中1例复发，1例发生髌骨内侧脱位，其余患者均取得较好疗效。软组织移植前后膝关节功能主观评分分别为46.99±5.91与94.40±9.70 (P < 0.01)，Lysholm膝关节功能综合评分在移植前后分别为44.37±4.49与90.10±11.00 (P < 0.01)，移植后髌骨-滑车适配角由移植前(16.27±6.74)°改善为移植后(5.33±8.78)°(P < 0.01)，髌股外侧角由移植前(-1.92±7.64)°改善为移植后(11.95±3.99)°(P < 0.01)。软组织移植治疗骨骺未闭儿童复发性髌骨脱位，简单易行、可操作性强、疗效确切，有利于缓解症状，改善膝关节功能。

Recurrent patellar dislocation in children treated with different soft tissue transplantation: A comparative study

BACKGROUND:Adult recurrent patellar dislocation is commonly treated with bone transplantation as it will not consider the damage to the epiphysis, but it is not suitable for child recurrent patellar dislocation, and most scholars choose the soft tissue transplantation to treat child recurrent patellar dislocation.OBJECTIVE:To retrospectively evaluate the clinical treatment effect of soft tissue transplantation for the treatment of child recurrent patellar dislocation with unclosed epiphysis in 22 cases.METHODS:Twenty-two patients (29 knees) with children recurrent patellar dislocation selected from the Department of Joint Surgery, Shanghai Changzheng Hospital during May 2006 and April 2009 were retrospectively analyzed. The patients were treated with soft tissue transplantation, and followed-up at 3 and 6 weeks, 3 months and 1 year after transplantation, and every year thereafter. The patellar stability, subjective symptoms and knee rehabilitation were evaluated.RESULTS AND CONCLUSION:Among the 22 patients, one case had recurrent patellar dislocation, one case had medial patellar dislocation, and the other cases obtained satisfactory effects. The subjective scoring of knee function before and after the soft tissue transplantation were 46.99±5.91 and 94.40±9.70, respectively (P < 0.01), comprehensive Lysholm knee function score before and after soft tissue transplantation were (44.37±4.49) and (90.10±11.00) respectively (P < 0.01), and the patella-tackle congruence angle was changed from preoperative (16.27±6.74)° to postoperative (5.33±8.78)° (P< 0.01), the lateral patellofemoral angle was changed from preoperative (-1.92±7.64)° to postoperative (11.95±3.99)° (P < 0.01). Soft tissue transplantation for the treatment of child recurrent patellar dislocation with unclosed epiphysis has the advantages of easy to operation, strong operability and satisfactory effect, and it is beneficial to relief symptoms and to improve knee function.