伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位的探讨  

Distal soft tissue surgery of knee extensor device for congenital dislocation of patella in children

作　　者：胡斌[1] 王晓东[1] 

机构地区：[1]苏州大学附属儿童医院骨科,江苏省苏州市215000

出　　处：《临床小儿外科杂志》2016年第4期389-392,396,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位的方法及其效果评价。方法自2011年6月至2015年1月,我们采用伸膝装置远端联合软组织手术治疗儿童先天性髌骨脱位8例14膝,其中6例双侧,2例单侧;男性6例,女性2例,年龄7个月至12岁,平均6岁。比较手术前后疼痛或僵硬、髌下捻发感、膝关节活动度、关节功能、影像学检查主客观指标。结果 8例手术后均恢复良好,并获得随访,平均随访时间26.9个月。截止随访日,除1例10月龄合并多关节挛缩病例以外,其余均独立行走,步态正常,未诉疼痛,膝关节屈伸活动良好,下肢力线正常。1例1膝出现一过性再脱位,其余无再脱位。优良率达78.3%。术后Q角由20.5°±6.4°改善至16.7°±3.4°(t=4.128,P<0.05),股骨髁间角由150.8°±3.4°改善至140.7°±3.8°(t=6.347,P<0.05)。结论先天性髌骨脱位久之易致严重膝关节功能障碍,宜早诊断早治疗。伸膝装置远端联合软组织手术是一种治疗儿童先天性髌骨脱位安全有效的治疗方式。Objetive To explore the efficacy of distal soft tissue surgery of knee extensor device in chil-dren with congenital dislocation of the patella. Methods From June 2011 to January 2015,8 children with congenital dislocation of the patella underwent distal soft tissue surgery of knee extensor device.There were 6 males and 2 females with an average age of 72 （7 ~144）months.The involved sides were bilateral （n =6） and unilateral （n =2）.Clinical evaluations included pre and postoperative pain or stiffness,crepitus,knee range of movement,function of knee and Q angle plus femoral intercondylar angle on patellar axial radiograph by Merchant view. Results The average follow-up period was 26.9 months.Except for one 10-month-old pa-tient with multiple joint contractures,the remainder could walk independently and pain-free with a normal gait. And knee ranges of movement were excellent.One case had transient patellar redislocation.Excellent and good rate was 78.3%.Q angle improved from preoperatively 20.5 ＆#177;6.4＆#176;to postoperatively 16.7 ＆#177;3.4＆#176;（t =4.128,P ＆lt;0.05）and femoral intercondylar angle declined from preoperatively 150.8 ＆#177;3.4＆#176;to postoperatively 140.7 ＆#177;3.8＆#176;（t =6.347,P ＆lt;0.05）. Conclusions Long-term congenital dislocation of the patellar is sus-ceptible serious knee dysfunction.Early diagnosis and appropriate treatment are essential.Distal soft tissue surgery of knee extensor device is both effective and safe for correcting the congenital dislocation of patella in children.

关 键 词：髌骨脱位/先天性 软组织 外科手术 儿童 

分 类 号：R726.8[医药卫生—儿科]