Luhmann Scott J, O'Donnell June C, Fuhrhop Sara
Washington University School ofMedicine, St Louis Shriners Hospital for Children, and St Louis Children's Hospital, St Louis, MO, USA.
J Pediatr Orthop. 2011 Jan-Feb;31(1):65-71. doi: 10.1097/BPO.0b013e318202c42d.
The purpose of this study was to report early outcomes after patellar realignment surgery (PRS) was performed for patellar instability in children and adolescents.
The study cohort consisted of 23 patients (27 knees) who had PRS between March 1, 2000 and July 30, 2004, by a single surgeon, with a minimum 3-year follow-up and validated outcome measures. Preoperative diagnoses were dislocations in 22 knees and subluxations in 5 knees. The mean age was 14 years and 1 month.
Postoperatively, 2 knees had possible recurrent dislocation/subluxation episodes; neither required surgery. Persistent patellofemoral mechanical symptoms have been reported in 10 knees. At a mean follow-up of 5 years and 1 month, the mean Lysholm score was 69.3 and the mean International Knee Documentation Committee (IKDC) score was 65.6. The mean Tegner activity level was 5.4. Patients reported improvement in knee function and pain in 26 of 28 knees (93%). Significant group differences were identified for age at surgery, preoperative diagnosis, and length of preoperative knee symptoms. The group with scores ≥ 70 were younger (13.1 vs. 14.9 y), were all patellar dislocators (vs. 66% in the < 70 group), and with shorter length of symptoms (13 mo vs. 24 mo). In the ≥ 70 groups the Tegner activity levels were higher at 6.8 versus the < 70 group at 4.3.
At a mean of 5 years after PRS, 93% of patients reported persistent improvement in knee function and pain, and recurrent patellar dislocation/subluxation episodes were infrequent (7%). Despite the low rate of postoperative patellar instability the patients' subjective opinion of knee function was less than expected (mean IKDC 65.5). Further investigation is warranted to identify causes for this suboptimal outcome at a mean of 5 years postoperatively.
These data reinforce the recurring theme documented in other areas of orthopaedics of a disconnection between the "surgical" success (93% improved) and patient's subjective outcome (mean IKDC of 65.6).
Level III.
本研究旨在报告针对儿童和青少年髌骨不稳定进行髌骨重新排列手术（PRS）后的早期结果。
研究队列包括23例患者（27个膝关节），这些患者在2000年3月1日至2004年7月30日期间由同一位外科医生进行了PRS，且进行了至少3年的随访以及有效的结果测量。术前诊断为22个膝关节脱位，5个膝关节半脱位。平均年龄为14岁1个月。
术后，2个膝关节可能出现复发性脱位/半脱位发作；均无需手术。有10个膝关节报告存在持续的髌股关节机械性症状。在平均5年1个月的随访中，Lysholm平均评分为69.3，国际膝关节文献委员会（IKDC）平均评分为65.6。Tegner活动水平平均为5.4。28个膝关节中的26个（93%）患者报告膝关节功能和疼痛有所改善。在手术年龄、术前诊断和术前膝关节症状持续时间方面发现了显著的组间差异。评分≥70分的组年龄更小（13.1岁对14.9岁），均为髌骨脱位患者（<70分组中为66%），且症状持续时间更短（13个月对24个月）。在≥70分的组中，Tegner活动水平更高，为6.8，而<70分的组为4.3。
在PRS术后平均5年时，93%的患者报告膝关节功能和疼痛持续改善，复发性髌骨脱位/半脱位发作很少见（7%）。尽管术后髌骨不稳定发生率较低，但患者对膝关节功能的主观评价低于预期（IKDC平均分为65.5）。有必要进一步研究以确定术后平均5年时出现这种不理想结果的原因。
这些数据强化了骨科其他领域所记录的一个反复出现的主题，即“手术”成功（改善率93%）与患者主观结果（IKDC平均分为65.6）之间存在脱节。
三级。
