关节镜辅助下三联法治疗儿童髌骨固定型脱位的疗效观察
The clinical effect of arthroscopic assisted reconstruction with three in one methodology on the treatment of patellar fixation dislocation
目的 探讨关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定型脱位临床疗效。 方法 回顾分析2014年1月至2017年1月收治10例12膝儿童髌骨固定型脱患者资料，男6例8膝，女4例4膝；年龄为4~9岁，平均6.6岁。所有患者均采用关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定型脱位，术后随访根据髌骨稳定度及Kujala 评分评定膝关节功能恢复情况。 结果 10例儿童术后获得6~18个月（平均随访12个月）随访。所有儿童末次随访髌骨稳定度满意，Kujala 评分由术前的（42.12±14.37）分增加到随访时的（95.68±9.42）分，差异有统计学意义（P＜0.05）。 结论 关节镜辅助下应用异体韧带悬吊式重建内侧髌股韧带（MPFL）、外侧支持带Y形松解，结合股内侧肌成形治疗儿童髌骨固定性脱位临床疗效满意，可以有效增加髌骨稳定性，改善膝关节功能，对骨骺不造成损害，是一种有效的治疗儿童髌骨固定型脱位的手术方法。
Objective To investigate the clinical effect of arthroscopy assisted reconstruction of medial patellofemoral ligament (MPFL), lateral retinaculum with Y-shaped release, and femoral medial muscle formation on the treatment of patellar fixation dislocation. Methods 10 patients with 12 knees were treated with patellar fixation dislocation from January 2014 to January 2017 were retrospectively reviewed, including 6 males with 8 knees and 4 females with 4 knees. The age was from 4 to 9 years (mean 6.6 years). All patients underwent arthroscopy assisted reconstruction of the medial patellofemoral ligament (MPFL) with allogeneic ligaments, Y-shaped dissection of the lateral retinaculum, combined with femoral medial muscle formation in the treatment of patellar fixation dislocation. Postoperative follow-up was performed to assess knee functional recovery based on patellar stability and Kujala score. Degree and Kujala score were applied to assess functional recovery of knee joint. Results 10 patients were followed up for 6 to 18 months (mean follow - up of 12 months). The Kujala score increased from (42.12±14.37) to (95.68±9.42), the difference was statistically significant (P<0.05). Conclusion The use of allograft ligament in the reconstruction of medial patellofemoral ligament (MPFL), lateral retinaculum with Y-shaped release, combined with femoral medial muscle formation treatment of children with patellar fixation dislocation clinical efficacy is satisfactory, and can effectively improve patellar stability, the knee function, and the epiphyseal is not damaged, which is an effective treatment of children with patellar fixation dislocation of the surgical method.
Child / Patella instability / Avoid the damage to the epiphyseal plate / Patellar fixation dislocation
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