Joo S Y, Park K B, Kim B R, Park H W, Kim H W
Department of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-Gu, Seoul 120-752, Korea.
J Bone Joint Surg Br. 2007 Dec;89(12):1645-9. doi: 10.1302/0301-620X.89B12.19398.
We describe our experience with the 'four-in-one' procedure for habitual dislocation of the patella in five children (six knees). All the patients presented with severe generalised ligamentous laxity and aplasia of the trochlear groove. All had a lateral release, proximal 'tube' realignment of the patella, semitendinosus tenodesis and transfer of the patellar tendon. The mean age at the time of the operation was 6.1 years (4.9 to 6.9), and the patients were followed up for a mean of 54.5 months (31 to 66). The clinical results were evaluated using the Kujala score. There has been no recurrence of dislocation. All the patients have returned to full activities and the parents and children were satisfied with the clinical results. The mean Kujala score was 95.3 (88 to 98). Two patients had marginal skin necrosis which healed after debridement and secondary closure. These early results in this small group have shown that the 'four-in-one' procedure is effective in the treatment of obligatory dislocation of the patella in children with severe ligamentous laxity and trochlear aplasia.
我们描述了对5名儿童（6个膝关节）进行髌骨习惯性脱位“四合一”手术的经验。所有患者均表现为严重的全身性韧带松弛和滑车沟发育不全。所有患者均接受了外侧松解、髌骨近端“管状”重新排列、半腱肌肌腱固定术和髌腱转移术。手术时的平均年龄为6.1岁（4.9至6.9岁），患者平均随访54.5个月（31至66个月）。使用库亚拉评分评估临床结果。脱位未复发。所有患者均恢复了全部活动，家长和孩子对临床结果满意。库亚拉评分平均为95.3（88至98）。两名患者出现边缘性皮肤坏死，经清创和二期缝合后愈合。该小样本的早期结果表明，“四合一”手术对于治疗伴有严重韧带松弛和滑车发育不全的儿童髌骨习惯性脱位有效。
