关节镜辅助下治疗儿童习惯性髌骨脱位的疗效分析  

Clinical efficacy of arthroscopy for habitual patellar dislocation in children

作　　者：文玉伟 齐克飞 于嘉智[1] 王春华[1] 刘涛[1] Wen Yuwei;Qi Kefei;Yu Jiazhi;Wang Chunhua;Liu Tao(Department of Orthopedic Trauma Surgery,Affiliated Children's Hospital,Shandong University,Jinan Children's Hospital,Jinan 250022,China;Department of Orthopedics,Municipal Women&Children's Hospital,Qingdao 266011,China;Department of Orthopedics,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]山东大学附属儿童医院(济南市儿童医院)骨科创伤外科,济南250022 [2]青岛市妇女儿童医院骨科,青岛266011 [3]国家儿童医学中心,首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《临床小儿外科杂志》2024年第2期152-157,共6页Journal of Clinical Pediatric Surgery

基　　金：济南市卫生健康委员会科技计划项目,关节镜辅助伸膝装置重建术治疗儿童习惯性髌骨脱位疗效分析(2021—2—102)

摘　　要：目的分析关节镜辅助下手术治疗儿童习惯性髌骨脱位的临床疗效。方法回顾性分析2015年7月至2021年7月济南市儿童医院骨科创伤外科收治的20例(22膝)习惯性髌骨脱位患儿临床资料,男8例、女12例,年龄5.8~15岁(平均8.5岁)。按照手术方式分为关节镜组(9例,10膝)和切开组(11例,12膝)。关节镜组采用关节镜辅助手术治疗,切开组采用传统切开手术。两组术式均为膝关节外侧松解、内侧紧缩及髌韧带半腱转移。比较两组患儿基本临床资料、髌股适合角、外侧髌股角和膝关节Lysholm评分之间差异。结果20例患儿(22膝)均顺利完成手术,平均随访24个月(18~36个月),患儿均恢复膝关节正常活动范围,无一例伤口感染等并发症;切开组再脱位1例,关节镜组无一例相关并发症。关节镜组与切开组基本临床资料差异无统计学意义(P>0.05),关节镜组与切开组手术时间[95.5(94.3,97.8)min比99.0(95.0,111.3)min]、出血量[(23.00±5.89)mL比(50.83±8.21)mL]、切口长度[(6.60±0.70)cm比(13.50±2.39)cm]、住院时间[7.0(7.0,9.0)d比9.0(7.0,10.0)d]、膝关节恢复正常活动时间[(65.50±6.43)d比(75.83.00±11.25)d]、完全负重时间[(8.70±0.95)周比(10.58±2.02)周]、术后膝关节功能评分[95.00(92.75,95.25)分比90.00(86.25,94.25)分]比较,差异均有统计学意义(P<0.05);术后髌股适合角[(-8.2±1.75)°比(-8.5±2.32)°]、外侧髌股角[(6.80±1.87)°比(7.17±1.64)°]比较,差异无统计学意义(P>0.05)。结论关节镜辅助治疗儿童习惯性髌骨脱位临床效果优于传统切开方式,具有切口小、术中出血量少、手术时间与住院时间短、膝关节功能恢复良好等优点,且不会出现术后再脱位,是习惯性髌骨脱位的有效治疗方法。Objective To explore the clinical efficacy of arthroscopy for habitual patellar dislocation(HPD)in children.Methods From July 2015 to July 2021,retrospective review was conducted for 20 HPD children.There were 8 boys and 12 girls with an age range of(5.8-15)year.According to different surgical approaches,they were assigned into two groups of arthroscopy(n=9 with 10 knees)and open(n=11 with 12 knees).Lateral release,medial contraction and patellar ligament semitendinous transfer were performed.Two groups were compared in terms of basic clinical profiles,imaging examinations and Lysholm score of knee.Results During an average follow-up period of 24(18-36)month,there was no wound infection or other complications.Redislocation(n=1)occurred in open group.Two groups were similar in basic profiles(P>0.05).Operative duration of arthroscopy and open groups was[95.5(94.3,97.8)vs.99.0(95.0,111.3)min],blood loss[(23.00±5.89)vs.(50.83±8.21)ml],incision length[(6.60±0.70)vs.(13.50±2.39)cm],length of hospital stay[7.0(7.0,9.0)vs.9.0(7.0,10.0)day],time to full weight bearing[(8.70±0.95)vs.(10.58±2.02)week],normal knee activity[(65.50±6.43)vs.(75.83.00±11.25)day]and postoperative Lysholm score of knee[95.00(92.75,95.25)vs.90.00(86.25,94.25)].And there were significant inter-group statistical differences(P<0.05).No significant difference existed in patellofemoral fitting angle[(-8.2±1.75)vs.(-8.5±2.32)degree]or lateral patellofemoral angle[(6.80±1.87)vs.(7.17±1.64)degree].Conclusions For HPD,arthroscopic lateral release,medial contraction and patellar ligament semitendinous transfer is superior to traditional incision.It offers a smaller incision,shorter operative duration,minimal intraoperative hemorrhage,shorter hospitalization stay and faster recovery of knee function.There is no redislocation.

关 键 词：髌骨脱位 关节镜检查 外科手术 治疗结果 儿童 

分 类 号：R726.8[医药卫生—儿科]