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先天性髌骨脱位——手术治疗原理与文献综述

Congenital Dislocation of the Patella - Surgical Treatment Rationale and Literature Review.

作者信息

Pedrotti Luisella, Bertani Barbara, De Rosa Federica, Fossati Federica, Ghilotti Margherita, Mora Redento, Tuvo Gabriella, Mosconi Mario

机构信息

Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Locomotor System Diseases Unit, University of Pavia, Pavia, Italy.

出版信息

J Orthop Case Rep. 2021 Apr;11(4):59-64. doi: 10.13107/jocr.2021.v11.i04.2154.

Abstract

INTRODUCTION

Congenital dislocation of the patella (CDP) is a rare condition and its treatment is not well defined. In CDP, patella is dislocated on the lateral aspect of the distal femur, laterally from the trochlear groove, it cannot be reduced manually and it is almost always associated with genu valgum, lateral torsion of the proximal tibia, and flexion contracture of the knee. This condition is present at birth, but the clinical findings can be subtle at birth due to the size and character of the structures being examined; early diagnosis is essential, but it may be delayed to late childhood or adulthood. If CDP is not promptly treated, the disability increases during growth, so surgical correction should be planned as soon as the diagnosis is confirmed.

CASE REPORT

We report a case of bilateral CDP associated with bilateral proximal radioulnar joint stiffness; the patient at the age of diagnosis was 11 years old and underwent a bilateral delayed surgical procedure; the 4-year follow-up results are satisfactory. Surgical treatment rationale and literature are reviewed.

CONCLUSION

Surgical correction for CDP is generally recommended, but there is no agreement in literature on the ideal treatment and in some cases, with mild impairment of the knee function, observation alone has been suggested. The decision about a surgical treatment can be difficult and depends on the degree of disability of the patient.

摘要

引言

先天性髌骨脱位(CDP)是一种罕见病症,其治疗方法尚无明确定义。在先天性髌骨脱位中,髌骨位于股骨远端外侧,偏离滑车沟外侧,无法手法复位,且几乎总是伴有膝外翻、胫骨近端外侧扭转和膝关节屈曲挛缩。这种情况在出生时就存在,但由于所检查结构的大小和特征,出生时的临床症状可能不明显;早期诊断至关重要,但可能会延迟至儿童晚期或成年期。如果先天性髌骨脱位未得到及时治疗,随着生长,残疾程度会增加,因此一旦确诊就应计划进行手术矫正。

病例报告

我们报告一例双侧先天性髌骨脱位合并双侧近端桡尺关节僵硬的病例;确诊时患者11岁,接受了双侧延迟手术;4年的随访结果令人满意。对手术治疗的原理和文献进行了综述。

结论

一般建议对先天性髌骨脱位进行手术矫正,但文献中对于理想的治疗方法尚无共识,在某些膝关节功能轻度受损的情况下,有人建议仅进行观察。关于手术治疗的决定可能很困难,这取决于患者的残疾程度。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bcc1/8310645/df940aea86d4/JOCR-11-59-g002.jpg

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