改良Langenskiold术和Grammont术联合治疗先天性及习惯性髌骨脱位的短期疗效观察

Immediate efficacy of modified Langenskiold and Grammont procedure for children with congenital or habitual patella dislocations

目的介绍一种治疗先天性及习惯性髌骨脱位的新手术方式,并通过对短期疗效的观察,评估此手术方式的可行性。方法收集2018年8月至2019年1月复旦大学附属儿科医院小儿骨科通过改良Langenskiold和Grammont手术方法联合治疗的先天性或习惯性髌骨脱位患儿病史资料,对术后膝关节功能进行评价,评估上述手术方式的可行性。结果期间共治疗8例9膝,其中先天性髌骨脱位5例,习惯性髌骨脱位3例。8例中男2例,女6例;左侧6例,右侧1例,双侧1例;平均手术年龄5.9岁(1.4~10.7岁)。术后根据患儿髌骨有无再脱位、膝关节屈伸功能、走路有无疼痛评估手术疗效。术后24周随访所有患儿膝关节活动正常。8例至最后一次随访均未发生髌骨再脱位;其中7例膝关节功能评价为优(87.5%),1例因术前术后均无法行走,故无法评价术后膝关节功能等级。结论从短期结果看,改良Langenskiold和Grammont方法联合治疗先天性及习惯性髌骨脱位是可行的,但长期疗效有待进一步随访观察。

Objective To introduce a new surgical procedure for congenital and habitual patella dislocations and evaluate its feasibility.Methods From August 2018 to January 2019,clinical data were collected for 8 hospitalized children(9 knees)with congenital and habitual patellar dislocations undergoing modified Langenskiold and Grammont procedure.The immediate operative efficacy was evaluated.Results There were congenital(n=5)and habitual(n=3)patella dislocation.There were 2 boys and 6 girls.The involved side was left(n=6),right(n=1)and bilateral(n=1).The average operative age was 5.9(1.4-10.7)years.Clinical outcomes were evaluated according to whether or not there was redislocation,range of motion(ROM)of knee joint and extent of walking pain.During a 24-week follow-up period,ROM was all normal and redislocation absent.Seven children(87.5%)had excellent knee function.One child could not be evaluated due to not walking before and after operation.Conclusion The immediate outcome of modified Langenskiold and Grammont procedure is feasible for congenital and habitual patella dislocations.However,further follow-ups and observations are required for evaluating its long-term efficacy.