本文選題：髕骨脫位 + 復發(fā)　； 參考：《中華骨與關節(jié)外科雜志》2016年01期

【摘要】：背景:復發(fā)性髕骨脫位的手術方式很多。單獨每種手術方式都不能達到滿意的臨床效果,需采用聯(lián)合手術。但如何根據(jù)患者具體情況選擇哪幾種手術聯(lián)合并做到手術的精細化仍有待臨床研究。目的:探討術前影像學評估及基于評估確定的聯(lián)合手術方式治療復發(fā)性髕骨脫位的臨床效果。方法:回顧性分析2014年1月至2015年9月采用聯(lián)合手術方案治療的6例8膝成人復發(fā)性髕骨脫位患者。男2例2膝,女4例6膝;年齡19~35歲,平均26歲;病程2 d~23年,平均6年。術前均行髕骨脫位8大危險因素的評估:髕骨傾斜、脛骨結節(jié)外偏、高位髕骨、股骨前傾、脛骨外旋、膝外翻、股骨滑車發(fā)育異常及膝過伸�；谠u估結果確定并實施外側支持帶松解、脛骨結節(jié)移位、股骨旋轉(zhuǎn)截骨、脛骨旋轉(zhuǎn)截骨、膝外翻截骨、股骨滑車截骨或膝過伸矯形術的聯(lián)合手術方案。所有患者均行內(nèi)側髕股韌帶(medial patella femoral ligament,MPFL)重建。比較術前、術后的Lysholm評分及Kujala評分。結果:髕骨傾斜角,術前平均為33.5°±12.7°(20.6°~60.7°),術后平均為10.5°±3.9°(4.6°~16.1°),較術前糾正23.0°±11.0°(10.2°~44.6°);脛骨結節(jié)-股骨滑車間距(tibial tubercle-trochlear groove distance,TT-TG值),術前平均為(20.4±6.1)mm(11.6 mm~30.2 mm),術后平均為(11.5±5.2)mm(3.9 mm~18.7 mm),較術前糾正(8.9±7.8)mm(8.8 mm~17.8 mm);Caton-Deschamps指數(shù),術前平均為1.17±0.16(1.01~1.47),術后平均為1.09±0.08(1.02~1.18),較術前糾正0.08±0.15(0~0.33)。2例3膝采用外側松解+MPFL重建術;2例3膝采用外側松解+脛骨結節(jié)內(nèi)移+MPFL重建術;2例2膝采用外側松解+脛骨結節(jié)內(nèi)移、下移+MPFL重建術。全部獲得隨訪,隨訪時間1~20個月,平均9個月。隨訪期間所有患者膝關節(jié)屈伸活動良好,均無再脫位或半脫位,亦無其他并發(fā)癥發(fā)生。末次隨訪Lysholm評分為(91.57±2.64)分,較術前(52.57±5.88)分有明顯改善;Kujala評分為(90.57±3.74)分,較術前(59.86±6.47)分有明顯改善(P0.05)。結論:對術前影像學資料進行詳細評估,確定聯(lián)合手術方案,并指導每種手術的精細化實施,可使復發(fā)性髕骨脫位取得良好的治療效果。
[Abstract]:Background: there are many surgical methods for recurrent patellar dislocation. Each kind of operation alone can not achieve satisfactory clinical effect, and combined operation should be adopted. However, how to select which kinds of surgical combination according to the patient's specific conditions and how to refine the operation are still waiting for clinical study. Objective: to evaluate the clinical effect of preoperative imaging evaluation and combined surgical treatment of recurrent patellar dislocation. Methods: from January 2014 to September 2015, 6 cases (8 knees) with recurrent patellar dislocation were retrospectively analyzed. There were 2 knees in male and 6 knees in female, the age was 1935 years (mean 26 years) and the course of disease was 2 ~ 23 years (mean 6 years). Eight risk factors of patellar dislocation were evaluated before operation: patellar tilt, external deviation of tibial tubercle, high patella, femoral anterior tilt, tibial rotation, knee valgus, abnormal development of trochlear and overextension of knee. Based on the evaluation results, the combined operative protocols of lateral retinaculum release, tibial nodule displacement, femoral rotation osteotomy, tibial rotation osteotomy, knee valgus osteotomy, femoral trochlear osteotomy or knee hyperextension orthopedics were determined and performed. All patients underwent medial patella femoral ligamentum reconstruction. Lysholm score and Kujala score were compared before and after operation. 緇撴灉:楂岄鍊炬枩瑙，

本文編號：1980960