Department of Paediatric Orthopaedics, Medical University of Graz, Graz, Austria.
Acta Orthop. 2012 Oct;83(5):504-10. doi: 10.3109/17453674.2012.736168. Epub 2012 Oct 8.
In skeletally immature patients, surgical options due to recurrent patella dislocation are limited, because bony procedures bear the risk of growth disturbances. In this retrospective study, we report the long-term functional and radiographic outcome in skeletally immature patients using the modified Grammont surgical technique.
Between 1999 and 2004, 65 skeletally immature knees (49 children) were treated with a modified Grammont procedure: an open lateral release and a shift of the patella tendon insertion below the growth plate on the tuberositas tibia, allowing the tendon to medialize. At mean 8 (5.6-11) years after surgery, 58 knees in 43 patients were evaluated by clinical examination, from functional scores (Lysholm, Tegner), and from radiographs of the knees.
Mean Lysholm score was 82 postoperatively. Tegner score decreased from 6.2 to 5. Eight knees had a single dislocation within 3 months of surgery. 3 knees had repeated late dislocations, all with a high grade of trochlea dysplasia. 6 knees showed mild signs of osteoarthritis. No growth disturbances were observed.
The modified Grammont technique in skeletally immature patients allows restoration of the distal patella tendon alignment by dynamic positioning. Long-term results showed that there were no growth disturbances and that there was good functional outcome. However, patients with a high grade of trochlea dysplasia tended to re-dislocate.
在骨骼未成熟的患者中，由于复发性髌骨脱位，手术选择有限，因为骨手术有生长障碍的风险。在这项回顾性研究中，我们报告了使用改良 Grammont 手术技术治疗骨骼未成熟患者的长期功能和影像学结果。
1999 年至 2004 年间，65 例骨骼未成熟的膝关节（49 例儿童）接受了改良 Grammont 手术治疗：外侧切开松解术和髌骨肌腱插入点向胫骨结节下方移位，使肌腱向内侧移位。手术平均 8 年后（5.6-11 年），43 例患者中的 58 例膝关节通过临床检查、功能评分（Lysholm、Tegner）和膝关节影像学检查进行评估。
术后平均 Lysholm 评分为 82 分。Tegner 评分从 6.2 降至 5.8。8 例膝关节在术后 3 个月内发生单次脱位。3 例膝关节出现迟发性复发性脱位，均伴有滑车发育不良程度较高。6 例膝关节出现轻度骨关节炎迹象。未观察到生长障碍。
改良 Grammont 技术在骨骼未成熟的患者中允许通过动态定位恢复髌腱远端的对齐。长期结果表明，没有生长障碍，且功能结果良好。然而，滑车发育不良程度较高的患者往往会再次脱位。
