复合软组织手术对儿童习惯性髌骨脱位髌股关节适应性的影响  

Effects of combined soft-tissue surgery on adaptability of the patellofemoral joint in treatment of habitual patellar dislocation in children

作　　者：吕学敏[1] 闫桂森[1] 郭源[1] 代少君[1] 

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华骨科杂志》2010年第9期870-875,共6页Chinese Journal of Orthopaedics

基　　金：基金项目：国家自然科学基金委主任基金（30750011）

摘　　要：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.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.

关 键 词：髌骨脱位 膝关节 外科手术 

分 类 号：R726.8[医药卫生—儿科]