Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Department of Orthopedic Surgery, Nationwide Children's Hospital.
J Pediatr Orthop. 2020 Oct;40(9):503-508. doi: 10.1097/BPO.0000000000001610.
Congenital (fixed) and obligatory (habitual) patellar dislocations in children are a complex clinical and surgical challenge. Numerous individual surgical techniques have been described. This study aims to assess results, patient satisfaction, and complications after a combined Roux-Goldthwait procedure, vastus medialis obliquus advancement, Galeazzi procedure, and extensive, lateral release (4-in-1 extensor realignment) in the skeletally immature knee with obligatory, or fixed lateral patellar instability.
Records of children with congenital fixed or obligatory patellar instability, who underwent the 4-in-1 procedure at a single institution, were reviewed. Clinical results included ability and time for the return to activities of daily living (ADL) and sport, recurrent instability and/or dislocation, and necessity of long-term bracing. Continued pain was assessed by the Kujala Score. Complications including infection, recurrent instability, and the necessity for secondary procedures were recorded.
A total of 34 patients (46 knees) mean age 10.3±2.4 years, underwent the 4-in-1 procedure with a mean postoperative follow-up of 51.6±31.5 (range, 12 to 146) months. Sixteen patients (22 knees) responded to a phone interview and questionnaire. All 16 patients returned to ADL in a mean time of 10.3±2.4 weeks. Ninety-one percent returned to sport in a mean time of 23.1±15.5 weeks. Long-term bracing was required for 6 knees after the surgery. The mean Kujala Score was 93.0±5.2 (range, 83 to 100). Complications included 6 of 34 patients (18%) with recurrent instability at the latest follow-up and 2 with superficial wound infection.
Patients with obligatory or fixed lateral, patellar instability who undergo the 4-in-1 procedure have good short-term results with low complication rates. Return to ADL and sporting activity with minimal pain can be expected, usually without the need for long-term bracing. The 4-in-1 procedure is a viable option for skeletally immature patients with obligatory or fixed, lateral patellar instability.
Level IV-Therapeutic study.
儿童先天性（固定性）和习惯性（习惯性）髌骨脱位是一个复杂的临床和外科挑战。已经描述了许多单独的手术技术。本研究旨在评估在骨骼未成熟的膝关节中进行联合 Roux-Goldthwait 手术、股四头肌内侧斜肌推进、Galeazzi 手术和广泛外侧松解（4-in-1 伸肌矫正）后，习惯性或固定性外侧髌骨不稳定的结果、患者满意度和并发症。
回顾了在一家单机构接受 4-in-1 手术的先天性固定性或习惯性髌骨不稳定儿童的病历。临床结果包括日常生活活动（ADL）和运动的恢复能力和时间、复发性不稳定和/或脱位以及长期支具的必要性。通过 Kujala 评分评估持续性疼痛。记录包括感染、复发性不稳定和需要二次手术的并发症。
共有 34 名患者（46 膝），平均年龄 10.3±2.4 岁，接受了 4-in-1 手术，平均术后随访 51.6±31.5（范围 12 至 146）个月。16 名患者（22 膝）通过电话采访和问卷调查进行了回复。所有 16 名患者在平均 10.3±2.4 周内恢复了 ADL。91%的患者在平均 23.1±15.5 周内恢复了运动。手术后有 6 个膝关节需要长期支具。平均 Kujala 评分为 93.0±5.2（范围 83 至 100）。并发症包括 34 名患者中的 6 名（18%）在最新随访时出现复发性不稳定，2 名患者出现浅表伤口感染。
接受 4-in-1 手术的习惯性或固定性外侧髌骨不稳定患者具有良好的短期结果和低并发症发生率。可以预期患者能够在最小疼痛的情况下恢复 ADL 和体育活动，通常无需长期支具。对于习惯性或固定性外侧髌骨不稳定的骨骼未成熟患者，4-in-1 手术是一种可行的选择。
IV 级-治疗研究。
