成人复发性髌骨脱位的术前影像学评估与联合手术
发布时间：2018-06-05 06:21
本文选题：髌骨脱位 + 复发 ； 参考：《中华骨与关节外科杂志》2016年01期
【摘要】：背景:复发性髌骨脱位的手术方式很多。单独每种手术方式都不能达到满意的临床效果,需采用联合手术。但如何根据患者具体情况选择哪几种手术联合并做到手术的精细化仍有待临床研究。目的:探讨术前影像学评估及基于评估确定的联合手术方式治疗复发性髌骨脱位的临床效果。方法:回顾性分析2014年1月至2015年9月采用联合手术方案治疗的6例8膝成人复发性髌骨脱位患者。男2例2膝,女4例6膝;年龄19~35岁,平均26岁;病程2 d~23年,平均6年。术前均行髌骨脱位8大危险因素的评估:髌骨倾斜、胫骨结节外偏、高位髌骨、股骨前倾、胫骨外旋、膝外翻、股骨滑车发育异常及膝过伸。基于评估结果确定并实施外侧支持带松解、胫骨结节移位、股骨旋转截骨、胫骨旋转截骨、膝外翻截骨、股骨滑车截骨或膝过伸矫形术的联合手术方案。所有患者均行内侧髌股韧带(medial patella femoral ligament,MPFL)重建。比较术前、术后的Lysholm评分及Kujala评分。结果:髌骨倾斜角,术前平均为33.5°±12.7°(20.6°~60.7°),术后平均为10.5°±3.9°(4.6°~16.1°),较术前纠正23.0°±11.0°(10.2°~44.6°);胫骨结节-股骨滑车间距(tibial tubercle-trochlear groove distance,TT-TG值),术前平均为(20.4±6.1)mm(11.6 mm~30.2 mm),术后平均为(11.5±5.2)mm(3.9 mm~18.7 mm),较术前纠正(8.9±7.8)mm(8.8 mm~17.8 mm);Caton-Deschamps指数,术前平均为1.17±0.16(1.01~1.47),术后平均为1.09±0.08(1.02~1.18),较术前纠正0.08±0.15(0~0.33)。2例3膝采用外侧松解+MPFL重建术;2例3膝采用外侧松解+胫骨结节内移+MPFL重建术;2例2膝采用外侧松解+胫骨结节内移、下移+MPFL重建术。全部获得随访,随访时间1~20个月,平均9个月。随访期间所有患者膝关节屈伸活动良好,均无再脱位或半脱位,亦无其他并发症发生。末次随访Lysholm评分为(91.57±2.64)分,较术前(52.57±5.88)分有明显改善;Kujala评分为(90.57±3.74)分,较术前(59.86±6.47)分有明显改善(P0.05)。结论:对术前影像学资料进行详细评估,确定联合手术方案,并指导每种手术的精细化实施,可使复发性髌骨脱位取得良好的治疗效果。
[Abstract]:Background: there are many surgical methods for recurrent patellar dislocation. Each kind of operation alone can not achieve satisfactory clinical effect, and combined operation should be adopted. However, how to select which kinds of surgical combination according to the patient's specific conditions and how to refine the operation are still waiting for clinical study. Objective: to evaluate the clinical effect of preoperative imaging evaluation and combined surgical treatment of recurrent patellar dislocation. Methods: from January 2014 to September 2015, 6 cases (8 knees) with recurrent patellar dislocation were retrospectively analyzed. There were 2 knees in male and 6 knees in female, the age was 1935 years (mean 26 years) and the course of disease was 2 ~ 23 years (mean 6 years). Eight risk factors of patellar dislocation were evaluated before operation: patellar tilt, external deviation of tibial tubercle, high patella, femoral anterior tilt, tibial rotation, knee valgus, abnormal development of trochlear and overextension of knee. Based on the evaluation results, the combined operative protocols of lateral retinaculum release, tibial nodule displacement, femoral rotation osteotomy, tibial rotation osteotomy, knee valgus osteotomy, femoral trochlear osteotomy or knee hyperextension orthopedics were determined and performed. All patients underwent medial patella femoral ligamentum reconstruction. Lysholm score and Kujala score were compared before and after operation. 缁撴灉:楂岄鍊炬枩瑙，
本文编号：1980960
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/1980960.html
最近更新
教材专著
