Grammont P M, Latune D, Lammaire I P
Orthopade. 1985 Sep;14(4):229-38.
The Elmslie method using a soft-tissue strip aims at realigning the extensor mechanism in the same way as the Elmslie-Trillat operation in adults. We feel that the main cause of dislocation or subluxation of the patella is to be found in incorrect alignment of this mechanism. We feel that the Q angle should especially be correct with regard to knee stability during rotation. This angle should not be neutralized or even inverted. In young, growing patients, as compared to adults, excess stress on the medial side due to medial displacement of the tuberosity will be compensated for by increasing valgus of the knee joint. Analysis of the potential risks involved in this pretuberosity operation led us to the conclusion that there is no risk of early epiphysiodesis or bony recurvation, and no risk of patella baja or osteochondrosis of the tuberosity. The functional results are so far very satisfactory (13 of 17 reexamined cases continue to be involved in sports or have taken up sports); this is particularly rewarding if we consider that the operation is not technically demanding and may even be undergone by ambulatory patients.
采用软组织条带的埃尔姆斯利方法旨在以与成人埃尔姆斯利-特里拉特手术相同的方式重新调整伸肌机制。我们认为髌骨脱位或半脱位的主要原因在于该机制的排列不正确。我们认为,就旋转时的膝关节稳定性而言,Q角尤其应该正确。这个角度不应被中和甚至反转。与成人相比,在年轻的生长发育期患者中,由于结节内侧移位导致的内侧过度应力将通过增加膝关节外翻来代偿。对这种结节前手术潜在风险的分析使我们得出结论,不存在早期骨骺闭合或骨质反曲的风险,也不存在髌骨低位或结节骨软骨病的风险。到目前为止,功能结果非常令人满意(17例复查病例中有13例继续参与运动或开始从事运动);如果我们考虑到该手术在技术上要求不高,甚至门诊患者也可以接受,这尤其值得欣慰。