Wada Akifusa, Fujii Toshio, Takamura Kazuyuki, Yanagida Haruhisa, Surijamorn Panya
Department of Orthopaedic Surgery, Fukuoka Children's Hospital, 2-5-1 Tojinmachi, Chuo-ku, Fukuoka, 810-0063, Japan.
J Child Orthop. 2008 Mar;2(2):119-23. doi: 10.1007/s11832-008-0090-4. Epub 2008 Mar 4.
Congenital dislocation of the patella is permanent and manually irreducible, and it manifests immediately after birth with flexion contracture of the knee, genu valgus, external tibial torsion and foot deformity. We retrospectively reviewed the results of operative treatment of seven knees in six patients with congenital dislocation of the patella.
The age of the six patients at diagnosis ranged from 8 days to 3.6 years, with an average of 1.3 years, and their age at the time of operation ranged from 0.6 to 3.9 years, with an average of 2.1 years. Serial casting and/or a brace was attempted before surgery in five of seven knees, leading to improvement in the flexion contracture of the knee. All knees were treated operatively in combination with lateral release, medial plication, V-Y lengthening of the quadriceps, medial transfer of the lateral patellar tendon and posterior release of the knee.
Although these deformities were noticed at birth in all seven knees, diagnosis was delayed in three knees due to the low suspicion of the disease and invisible patellae on radiographs. Ultrasonography confirmed the diagnosis of dislocation. The patella was centered in the groove of the femoral condyle after surgery in all knees, but subluxation of the knee with flexion was observed in one knee in which the operation was performed at 3.9 years. Genu valgus and external tibial torsion improved after surgery in all knees. The operated knee was mobile in all cases, with less than 10 degrees flexion contracture of the knee. Flexion contracture did not increase in any of the knees.
Congenital dislocation of the patella should be suspected in every patient with knee flexion contracture, genu valgus, external tibial torsion, foot deformity and delayed walking. Successful results were obtained when the operation was performed in younger children. Other procedures, such as the semitendinosus tenodesis or tendon transfer, might have to be combined to achieve better stability with flexion in older children.
先天性髌骨脱位是永久性的且手法不可复位，出生后立即表现为膝关节屈曲挛缩、膝外翻、胫骨外旋和足部畸形。我们回顾性分析了6例先天性髌骨脱位患者7个膝关节的手术治疗结果。
6例患者诊断时年龄为8天至3.6岁，平均1.3岁，手术时年龄为0.6至3.9岁，平均2.1岁。7个膝关节中的5个在手术前尝试了连续石膏固定和/或支具治疗，使膝关节屈曲挛缩有所改善。所有膝关节均采用外侧松解、内侧折叠、股四头肌V-Y延长、髌骨外侧肌腱内侧移位和膝关节后方松解联合手术治疗。
尽管所有7个膝关节在出生时就被发现有这些畸形，但由于对该疾病的怀疑较低且X线片上髌骨不可见，3个膝关节的诊断被延迟。超声检查确诊为脱位。所有膝关节术后髌骨均位于股骨髁间沟中心，但在3.9岁时接受手术的1个膝关节中，观察到膝关节在屈曲时半脱位。所有膝关节术后膝外翻和胫骨外旋均有改善。所有病例中手术膝关节均活动自如，膝关节屈曲挛缩小于10度。任何膝关节的屈曲挛缩均未加重。
对于每一位有膝关节屈曲挛缩、膝外翻、胫骨外旋、足部畸形和行走延迟的患者，均应怀疑先天性髌骨脱位。在年幼儿童中进行手术可获得成功结果。对于年龄较大的儿童，可能需要联合其他手术，如半腱肌肌腱固定术或肌腱转移术，以在屈曲时获得更好的稳定性。
