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青少年患者的胫骨结节截骨术

Tibial Tubercle Osteotomy in the Adolescent Patient.

作者信息

Niu Emily L, Williams Brendan A, Stinson Zachary, Beck Jennifer J, Carsen Sasha, Ellington Matthew D, Ellis Henry B, Crepeau Allison, Mayer Stephanie, Patel Neeraj M, Pennock Andrew, Poon Selina, Vandenberg Curtis, Vanderhave Kelly

机构信息

Department of Orthopaedics, Children's National Hospital, Washington, DC.

Department of Orthopaedics, The Children's Hospital of Philadelphia, Philadelphia, PA.

出版信息

J Pediatr Soc North Am. 2024 Feb 5;5(4):750. doi: 10.55275/JPOSNA-2023-750. eCollection 2023 Nov.

DOI:10.55275/JPOSNA-2023-750
PMID:40432940
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12088202/
Abstract

Patellofemoral instability (PFI) is an increasingly prevalent issue affecting pediatric and adolescent patients. Anatomic factors, including lateralization of the tibial tubercle and patella alta, can contribute to increased risk of initial and recurrent PFI. In the case of recurrent PFI, chondral injuries of the patellofemoral compartment can occur. These anatomic pathologies can be surgically addressed using tibial tubercle osteotomy (TTO), adjusting the angle and direction of the osteotomy as needed to achieve the desired correction. We discuss the indications and present our technique for performing TTO, including the modifications that can be made to the procedure to address the specific pathoanatomy of the patient. •Lateral patellar instability is a common condition impacting adolescent patients with tibial tubercle lateralization and patella alta being common modifiable risk factors for recurrence.•The tibial tubercle osteotomy is a versatile procedure permitting the treatment of patellofemoral instability and associated cartilage injuries by adjusting the angle of the osteotomy cut and tubercle transfer as needed to address the specific pathology.•Risks of osteotomy are greater than soft tissue reconstruction procedures alone, but many can be mitigated with meticulous osteotomy and soft tissue closure techniques.

摘要

髌股关节不稳定（PFI）是一个在儿科和青少年患者中日益普遍的问题。解剖学因素，包括胫骨结节外移和高位髌骨，可导致初次和复发性PFI风险增加。对于复发性PFI，髌股关节腔可发生软骨损伤。这些解剖学病变可通过胫骨结节截骨术（TTO）进行手术治疗，根据需要调整截骨的角度和方向以实现所需的矫正。我们讨论其适应症并介绍我们进行TTO的技术，包括为解决患者特定的病理解剖结构而对该手术进行的改良。•外侧髌骨不稳定是一种常见病症，影响青少年患者，胫骨结节外移和高位髌骨是常见的可改变的复发风险因素。•胫骨结节截骨术是一种多功能手术，通过根据需要调整截骨角度和结节转移来治疗髌股关节不稳定及相关软骨损伤，以解决特定的病理问题。•截骨术的风险大于单纯的软组织重建手术，但通过细致的截骨术和软组织闭合技术，许多风险可以减轻。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/34879091c1a2/gr11.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/3f265200e4f8/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/66abd1594b8d/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/35e334e2d96d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/34879091c1a2/gr11.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/e18e0480d276/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/888865e9ea90/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/5b3c71c1bbb3/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/e9ff55039f61/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/5012f3e04eb6/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/aa0c7561ff93/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/eadb0b4d9bfc/gr7.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/3f265200e4f8/gr8.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/66abd1594b8d/gr9.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/35e334e2d96d/gr10.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/30de/12088202/34879091c1a2/gr11.jpg

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Tibial tubercle osteotomy for patellofemoral malalignment and chondral disease provided good outcomes: A systematic review.胫骨结节截骨术治疗髌股对线不良和软骨疾病的疗效良好：系统评价。
J ISAKOS. 2022 Apr;7(2):78-86. doi: 10.1016/j.jisako.2021.10.002. Epub 2021 Nov 17.
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Modified Langenskiöld procedure for congenital patella dislocations in pediatric patients.
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Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients.在美国，儿科和青少年患者中急性髌骨脱位和髌骨不稳定手术的发病率有所增加。
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Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort.髌股关节不稳定的儿童和青少年膝关节MRI中临床相关剩余生长的放射学评估的可靠性：来自JUPITER队列的数据
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