传统术式联合股骨下端成形术治疗青少年先天性髌骨脱位

Traditional surgery combined with plasty of femoral inferior extremity for the treatment of congenital dislocation of patella in adolescent

[目的]探讨传统术式联合股骨下端成形术治疗青少年先天性髌骨脱位的方法并评价其效果。[方法]自1996年10月～2004年8月,采用传统术式(膝关节外侧松解术,内侧关节囊紧缩术,股内侧肌止点移位术,髌韧带止点内移术,半腱肌肌腱转位术)联合股骨下端成形术治疗先天性髌骨脱位21例,其中男性13例,女性8例,平均年龄11岁(6～18岁)。17例为单侧髌骨脱位,4例为双侧(均只治疗1侧),无合并其他膝关节畸形。[结果]21例经联合手术治疗后均恢复良好。随访2～6年,平均3.5年,无髌骨再脱位发生,无手术并发症。21例膝关节均能完全伸直,17例膝关节屈曲良好(120°～150°),4例膝关节屈曲轻度受限(100°～120°),步态正常。[结论]青少年先天性髌骨脱位是一种极少见的畸形,应早期诊断并早期手术治疗,否则易发生髌股骨关节炎,传统术式联合股骨下端成形术治疗青少年先天性髌骨脱位效果满意。

[ Objective ] To explore the method of combined traditional surgery with plasty of femoral inferior extremity for the treatment of congenital dislocation of patella in adolescent and to estimate the result. [ Method] Totally 21 adolescent with congenital dislocation of patella were treated with the method of traditional surgery （ loosening the lateral tissues of knee, tightening the medial jiont capsule, transfer of vastus medialis, ingression of patella ligament insertion, transfer of semitendinosus tendon） and plasty of femoral inferior extremity from October 1996 and August 2004, there were 13 boys and 8 girls, the average age was 11 （6 - 18）. Seventeen of them were unilateral and 4 were bilateral without any other deformities. [ Result] Totally 21 cases recoverd well after combined surgery. The patients were followed up from 2 years to 6 years （ the average period was 3.5 years）, no patella redislocation and complication were found. All knee of cases can extend straightly, 17 cases can crook well （120° - 150°） and 4 cases crooked slightly limited （100° - 120°） , walking normally. [ Conclusion] The disease is a rare deformity, it should be interfered with diagnosis and operation as early as possible, or it can lead to the patellofemoral osteoarthritis. The method of combined surgery is satisfactory. Key words, dislocation; patella; combined surgery