骨骼未成熟患者的髌股关节不稳
Patellofemoral instability in skeletally immature patients.
作者信息
Machado Sara Alexandra Fernandes, Pinto Rui Alexandre Peixoto, Antunes Artur Jorge Afonso Martins, de Oliveira Paulo Alexandre Ribeiro
机构信息
Orthopedic Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, Porto, Portugal.
Anatomy Department, Oporto Medical School, Al. Prof. Hernâni Monteiro, Porto, Portugal.
出版信息
Porto Biomed J. 2017 Jul-Aug;2(4):120-123. doi: 10.1016/j.pbj.2016.12.007. Epub 2017 Apr 12.
HIGHLIGHTS
A decade after patellofemoral ligament reconstruction results remains satisfactory.It is a good option for patellar instability treatment in children.Patients with trochlear dysplasia benefit from trochleoplasty after physeal closure.
BACKGROUND
Patellofemoral instability is a common cause of knee disability. Acute patellofemoral dislocation is the most common acute knee disorder in skeletally immature patients. In this group, the incidence of patellofemoral dislocation is approximately 43 per 100,000 individuals.
THE PRECISE OBJECTIVE ADDRESSED IN THE PAPER
Medial patellofemoral ligament (MPFL) reconstruction has a significant role in the treatment of patellofemoral instability in skeletally immature patients. We evaluated the medium and long-term results results of MPFL reconstruction as the sole method of patellofemoral instability treatment and their relationship with the presence of other potentially associated factors.
METHODS
We conducted a prospective study with 35 young patients who underwent the same surgical technique between 2002 and 2009. Age, gender, patellar tilt, patella height, TT-TG, trochlear dysplasia, the Kujala score and the Tegner activity score were evaluated. Statistical analysis used SPSS 20.
RESULTS
The mean age of the patients was 15.9 years. High patella was observed in 10% of patients. All patients had TT-TG within a normal range. Trochlear dysplasia was found in 80% of the patients: 40% had Dejour's type A; 34% type B; 20% type C and 6% type D. The medium-term Kujala score (84 ± 9) significantly improved compared to the pre-operative score (54 ± 11). However, a decline in the long-term (78 ± 3) score was observed. The Tegner activity score showed a significant decrease. The long-term results were significantly lower when patients had trochlear dysplasia type B to D.
CONCLUSIONS
A decade after isolated MPFL reconstruction, results remained satisfactory. Patients with trochlear dysplasia types B to D may benefit from associated trochleoplasty in a second intervention.
要点
髌股韧带重建术后十年效果仍令人满意。这是治疗儿童髌骨不稳定的一个好选择。骨骺闭合后，滑车发育不良的患者可从滑车成形术中获益。
背景
髌股不稳定是膝关节残疾的常见原因。急性髌股脱位是骨骼未成熟患者中最常见的急性膝关节疾病。在这组人群中，髌股脱位的发病率约为每10万人中有43例。
本文探讨的精确目标
内侧髌股韧带（MPFL）重建在治疗骨骼未成熟患者的髌股不稳定中具有重要作用。我们评估了MPFL重建作为治疗髌股不稳定的唯一方法的中长期效果及其与其他潜在相关因素的关系。
方法
我们对2002年至2009年间接受相同手术技术的35例年轻患者进行了一项前瞻性研究。评估了年龄、性别、髌骨倾斜度、髌骨高度、TT-TG、滑车发育不良、库贾拉评分和特格纳活动评分。使用SPSS 20进行统计分析。
结果
患者平均年龄为15.9岁。10%的患者观察到高位髌骨。所有患者的TT-TG均在正常范围内。80%的患者发现有滑车发育不良：40%为德茹尔A型；34%为B型；20%为C型；6%为D型。与术前评分（54±11）相比，中期库贾拉评分（84±9）有显著改善。然而，观察到长期评分（78±3）有所下降。特格纳活动评分显著降低。当患者为B至D型滑车发育不良时，长期效果显著较低。
结论
单纯MPFL重建术后十年，效果仍然令人满意。B至D型滑车发育不良的患者可能在二次干预中受益于相关的滑车成形术。
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