中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2010年
9期
870-875
,共6页
吕学敏%闫桂森%郭源%代少君
呂學敏%閆桂森%郭源%代少君
려학민%염계삼%곽원%대소군
髌骨脱位%膝关节%外科手术
髕骨脫位%膝關節%外科手術
빈골탈위%슬관절%외과수술
Patellar dislocation%Knee joint%Surgical procedures,operative
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.
目的 研究複閤軟組織手術治療不同年齡段兒童習慣性髕骨脫位後,髕股關節適應性的變化情況.方法 迴顧性分析2000至2007年收治的習慣性髕骨脫位患兒73例.男24例,女49例;平均年齡7.1歲(3～15歲);單側47例,雙側26例.按照年齡分為A、B兩組:A組年齡3～8歲(包括8歲),24例(30膝);B組年齡8～15歲,49例(69膝).複閤軟組織手術包括膝關節外側充分鬆解、內側緊縮、髕腱半腱上點移位(Roux-Goldthwait手術)和股內側肌止點下移術.術前及隨訪中分彆行髕骨軸位和側位X線檢查,測量股骨滑車角、髕骨高度、髕骨-滑車適配角及髕骨傾斜角(Laurin角)的變化情況,以評價髕股關節適應性.結果 73例患兒均穫隨訪,平均隨訪38箇月(25～98箇月).末次隨訪時髕骨脫位均無複髮,其中2例髮生髕骨內側脫位.股骨滑車角:A組由術前的150.1°±5.1°改善為144.3°±6.0°,手術前後差異有統計學意義(P＜0.05);B組手術前後差異無統計學意義(P＞0.05).其餘測量指標在兩組均無顯著變化.結論 複閤軟組織手術對兒童習慣性髕骨脫位髕股關節的塑型有影響,對于手術年齡在8歲以下兒童可以明顯促進股骨髁的髮育,降低股骨滑車角,改善髕股關節適應性;8歲以上兒童在隨訪期內股骨滑車角的變化不顯著,髕股關節適應性改變不明顯.
목적 연구복합연조직수술치료불동년령단인동습관성빈골탈위후,빈고관절괄응성적변화정황.방법 회고성분석2000지2007년수치적습관성빈골탈위환인73례.남24례,녀49례;평균년령7.1세(3～15세);단측47례,쌍측26례.안조년령분위A、B량조:A조년령3～8세(포괄8세),24례(30슬);B조년령8～15세,49례(69슬).복합연조직수술포괄슬관절외측충분송해、내측긴축、빈건반건상점이위(Roux-Goldthwait수술)화고내측기지점하이술.술전급수방중분별행빈골축위화측위X선검사,측량고골활차각、빈골고도、빈골-활차괄배각급빈골경사각(Laurin각)적변화정황,이평개빈고관절괄응성.결과 73례환인균획수방,평균수방38개월(25～98개월).말차수방시빈골탈위균무복발,기중2례발생빈골내측탈위.고골활차각:A조유술전적150.1°±5.1°개선위144.3°±6.0°,수술전후차이유통계학의의(P＜0.05);B조수술전후차이무통계학의의(P＞0.05).기여측량지표재량조균무현저변화.결론 복합연조직수술대인동습관성빈골탈위빈고관절적소형유영향,대우수술년령재8세이하인동가이명현촉진고골과적발육,강저고골활차각,개선빈고관절괄응성;8세이상인동재수방기내고골활차각적변화불현저,빈고관절괄응성개변불명현.
Objective To explore adaptability of the patellofemoral joint after combined soft-tissue surgery in treatment of habitual patellar dislocation at different age. Methods Seventy-three children with habitual patellar dislocation were retrospectively reviewed from 2000 to 2007. There were 24 males and 49 females, with a mean age of 7.1 years(ranged 3-15). The mean follow-up period was 38 months (ranged 25-98). There were 24 patients with 30 knees aged from 3 to 8 years in A group and 49 cases with 69 knees aged from 8 to 15 years in B group. The combined soft-tissue surgery procedure consists of lateral capsular release, medial retinacular tightening of the knee, vastus medialis muscle transfer to the patella, medial and distal transfer of the half patellar tendon. Patella axial and knee lateral X-ray examination were obtained.Femoral trochlear angle,patellar height changes, patellofemoral congruence angle and patellar tilt angle (Laurin angle) were measured to evaluate adaptability of the patellofemoral joint. Results The data of 73 cases were complete. At the last visit, no recurrence of patellar lateral dislocation was found and two cases had patella medial dislocation. Femoral trochlear angle improved from 150.1°±5.1° preoperatively to 144.3°±6.0° postoperatively (P ＜0.05) in A group, while similar changes had not found (P ＞ 0.05) in B group. There were no difference in A and B group in regard to patellar height, congruence angle and Laurin angle. Conclusion The combined soft-tissue surgery had effect on patellofemoral joint remodel in children with habitual patellar dislocation. These procedures can significantly promote development of the femoral condyle, decrease femoral trochlear angle and improve adaptability of the patellofemoral joint in children under the age of 8 years. But it had no obvious influence on older than 8-year-old children.
