CAJ | 학술논문

目的观察儿童习惯性髌骨脱位的病理解剖学改变,为临床选择手术方法提供参考.方法回顾性分析2003年2月至2011年4月儿童习惯性髌骨脱位患儿19例28膝的临床资料.其中单侧10例,双侧9例,1例为Down综合征合并双侧髌骨脱位.术前X线测量髌股关节,术中用游标卡尺测量胫骨结节与股骨髁间沟中点距离,髌内、外侧支持带宽度比值和股内侧斜头止点角等解剖学参数.结果轴位和侧位X线片显示髌骨体积变小、髁间沟角平均＞150°、髌腱与髌骨比值平均＞1.4.解剖学异常包括髌内侧支持带增宽变薄,股外侧肌和髌外侧支持带严重挛缩,股内侧肌斜头止点角平均＜46°,胫骨结节与股骨髁间沟中点平均距离＞21 mm.结论儿童习惯性髌骨脱位的病理解剖学改变主要有股骨髁间沟变浅、股内侧肌斜头解剖轴线异常和胫骨结节相对外移,而外侧软组织挛缩和髌骨高位可能是继发性改变.外侧支持带及股外侧肌松解、股内侧肌斜头前置和髌腱内侧移位,是成功治疗本病的关键因素.
목적 관찰인동습관성빈골탈위적병리해부학개변,위림상선택수술방법제공삼고.방법 회고성분석2003년2월지2011년4월인동습관성빈골탈위환인19례28슬적림상자료.기중단측10례,쌍측9례,1례위Down종합정합병쌍측빈골탈위.술전X선측량빈고관절,술중용유표잡척측량경골결절여고골과간구중점거리,빈내、외측지지대관도비치화고내측사두지점각등해부학삼수.결과 축위화측위X선편현시빈골체적변소、과간구각평균＞150°、빈건여빈골비치평균＞1.4.해부학이상포괄빈내측지지대증관변박,고외측기화빈외측지지대엄중련축,고내측기사두지점각평균＜46°,경골결절여고골과간구중점평균거리＞21 mm.결론 인동습관성빈골탈위적병리해부학개변주요유고골과간구변천、고내측기사두해부축선이상화경골결절상대외이,이외측연조직련축화빈골고위가능시계발성개변.외측지지대급고외측기송해、고내측기사두전치화빈건내측이위,시성공치료본병적관건인소.
Objective To study the pathological and morphological characteristics of the children with habitual dislocation of patella.Methods From February 2003 to April 2011,19 children with habitual patella dislocation underwent surgical repair at this center.The pathological and morphological changes of the 28 knees were examined during operation.These patients included 9 females and 10 males,with a mean age of 11.8 years old.One girl with bilateral dislocation of patella was diagnosed with Down syndrome.Preoperative radiography was studied to determine the anatomic connection between patella and femor.Pathological changes of soft tissues around patella were also studied.Results On radiogram,both lateral and axial size of patella in patients was smaller than that of controls.Mean Insall ratio was more than 1.4 and mean trochlear sulcus angle was 150.The pathological findings included widely attenuation of medial retinacular tissue,sever contractures of vastus lateralis and lateral retinaculum.The mean vastus medialis oblique insertion angle was 46.The distance between tibial tubercle and trochlear groove was increased with the average distance of 21 mm.Conclusions Shallow trochlear sulcus,decreased vastus medialis oblique insertion angle as well as increased distance between tibial tubercle and trochlear groove are pathological and morphological characteristics of the children with habitual dislocation of patella.