本文選題：髕骨脫位 + 復(fù)發(fā)�。� 參考：《中華骨與關(guān)節(jié)外科雜志》2016年01期

【摘要】：背景:復(fù)發(fā)性髕骨脫位的手術(shù)方式很多。單獨每種手術(shù)方式都不能達到滿意的臨床效果,需采用聯(lián)合手術(shù)。但如何根據(jù)患者具體情況選擇哪幾種手術(shù)聯(lián)合并做到手術(shù)的精細化仍有待臨床研究。目的:探討術(shù)前影像學(xué)評估及基于評估確定的聯(lián)合手術(shù)方式治療復(fù)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(shù)方案治療的6例8膝成人復(fù)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(shù)前均行髕骨脫位8大危險因素的評估:髕骨傾斜、脛骨結(jié)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(jié)果確定并實施外側(cè)支持帶松解、脛骨結(jié)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(shù)的聯(lián)合手術(shù)方案。所有患者均行內(nèi)側(cè)髕股韌帶(medial patella femoral ligament,MPFL)重建。比較術(shù)前、術(shù)后的Lysholm評分及Kujala評分。結(jié)果:髕骨傾斜角,術(shù)前平均為33.5°±12.7°(20.6°~60.7°),術(shù)后平均為10.5°±3.9°(4.6°~16.1°),較術(shù)前糾正23.0°±11.0°(10.2°~44.6°);脛骨結(jié)節(jié)-股骨滑車間距(tibial tubercle-trochlear groove distance,TT-TG值),術(shù)前平均為(20.4±6.1)mm(11.6 mm~30.2 mm),術(shù)后平均為(11.5±5.2)mm(3.9 mm~18.7 mm),較術(shù)前糾正(8.9±7.8)mm(8.8 mm~17.8 mm);Caton-Deschamps指數(shù),術(shù)前平均為1.17±0.16(1.01~1.47),術(shù)后平均為1.09±0.08(1.02~1.18),較術(shù)前糾正0.08±0.15(0~0.33)。2例3膝采用外側(cè)松解+MPFL重建術(shù);2例3膝采用外側(cè)松解+脛骨結(jié)節(jié)內(nèi)移+MPFL重建術(shù);2例2膝采用外側(cè)松解+脛骨結(jié)節(jié)內(nèi)移、下移+MPFL重建術(shù)。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(guān)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(shù)前(52.57±5.88)分有明顯改善;Kujala評分為(90.57±3.74)分,較術(shù)前(59.86±6.47)分有明顯改善(P0.05)。結(jié)論:對術(shù)前影像學(xué)資料進行詳細評估,確定聯(lián)合手術(shù)方案,并指導(dǎo)每種手術(shù)的精細化實施,可使復(fù)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