内侧筋膜条转位治疗儿童髌骨脱位

Medial fascia strip transfer for patella dislocation in children

[目的]介绍髌骨内侧筋膜条转位联合缝线增强及内侧紧缩治疗儿童髌骨脱位的手术技术和初步结果。[方法]2020年3月—2022年9月,作者对髌骨脱位15例儿童采用上述手术治疗。首先行关节镜检查,清理关节腔内积血和软骨小碎块,清除增生滑膜组织。于髌骨内侧缘行4 cm切口,沿髌骨内侧纵向切取宽约1 cm的筋膜条,保留近近端附着完整,远端编织缝合;筋膜条经皮下引至股骨内上髁,用缝线锚钉固定,最后紧缩缝合髌骨内侧筋膜。[结果]15例患者均顺利完成手术,术后随访2~30个月,随访期间均未发生髌骨再脱位或半脱位。Lysholm评分由术前(59.9±9.3)分提高至末次随访时(91.7±4.5)分,差异均有统计学意义(P<0.05);影像测量髌骨倾斜角(patellar tilt angle,PTA)由术前(30.5±8.9)°减小至末次随访时(7.0±2.9)°,差异有统计学意义(P<0.05)。[结论]髌骨内侧筋膜条转位联合缝线增强及内侧紧缩治疗儿童髌骨脱位技术简单易行,初期疗效满意,但远期疗效有待进一步观察。

[Objective]To introduce the surgical technique and preliminary clinical outcome of medial patellar fascia strip transfer combined with suture enhancement and medial tightening for patella dislocation in children.[Methods]From March 2020 to September 2022,15 children received abovementioned surgical procedures for patella.After arthroscopy was performed to remove the blood clot,carti-lage fragments and the hyperplastic synovial tissue,a 4 cm longitudinal incision was made along the medial edge of the patella.A fascia strip 1cm in width was cut longitudinally along the medial edge of the patella.The proximal attachment of the fascia bundle was kept intact,while the distal end was freed and sutured with stitches.Then,the fascia bundle was led subcutaneously to the medial femoral epicondyle and fixed with sutures anchors.The fascia defect on the medial patella was closed with tight sutured.[Results]All the 15 patients were suc-cessfully operated on,and followed up for 2 to 30 months.No patellar re-dislocation or subluxation occurred in anyone of them during the follow-up period.The Lysholm score increased from(59.9±9.3)before surgery to(91.7±4.5)at the last follow-up with a statistical signifi-cance(P<0.05).In addition,the patellar tilt angle(PTA)measured on CT significantly decreased from(30.5±8.9)°preoperatively to(7.0±2.9)°at the latest follow-up(P<0.05).[Conclusion]The medial patellar fascia strip transfer combined with suture enhancement and medial tightening is simple and feasible treatment for patella dislocation in children with satisfactory initial outcome,while the long-term efficacy needs to be further observed.