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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Tibial Tubercle Proximalization: A Novel Technique to Lengthen the Extensor Mechanism in Skeletally Mature Patients With Lateral Habitual Patellar Dislocations
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Tibial Tubercle Proximalization: A Novel Technique to Lengthen the Extensor Mechanism in Skeletally Mature Patients With Lateral Habitual Patellar Dislocations

机译：胫骨结节近端：延长侧卧位Ha骨脱位的骨骼成熟患者伸肌机制的一种新技术。

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Background: A habitual patellar dislocation (HPD) is a rare condition in skeletally mature patients, especially for those with severe quadriceps contracture. Until now, no study has reported the effectiveness of tibial tubercle proximalization to lengthen the extensor mechanism in treating severe HPDs in skeletally mature patients. Purpose: To describe a novel comprehensive procedure that includes tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and medial patellofemoral ligament (MPFL) reconstruction in treating severe HPDs in skeletally mature patients and to report its early clinical outcomes. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 to May 2016, a total of 43 consecutive patients (47 knees) with HPDs were surgically treated at a single institution and were retrospectively reviewed. Among them, 11 skeletally mature patients (11 knees) with severe primary HPDs underwent the index comprehensive procedure. Results of patellar tracking were recorded preoperatively and at the final follow-up. The radiological assessment included radiographs in standard anteroposterior, true lateral, and axial views and computed tomography scans at full knee extension before surgery and at the final follow-up. Subjective patellofemoral function was evaluated with the Kujala functional score before the index procedure and at the final follow-up visit. Results: The 11 included patients were evaluated for a mean period of 34.9 months (range, 25-46 months). The mean knee flexion angle when the patella dislocated laterally was 25° (range, 10°-30°) preoperatively. Radiologically, there was a statistically significant improvement in the congruence angle, from 73.4° ± 17.0° preoperatively to –7.1° ± 5.8° postoperatively ( P & .01) and in the lateral patellofemoral angle, from –65.6° ± 9.4° preoperatively to 6.1° ± 2.7° postoperatively ( P & .01). The mean preoperative Kujala functional score was 42.9, and the mean postoperative Kujala functional score was 95.2 ( P & .05). No patients reported a recurrence of patellar dislocation at the final follow-up visit. Conclusion: The novel comprehensive procedure, including tibial tubercle proximalization, extensive lateral release, tibial tubercle medialization, and MPFL reconstruction, effectively treated lateral HPDs in skeletally mature patients with severe quadriceps contracture.
机译：背景：习惯性tell骨脱位（HPD）在骨骼成熟的患者中很少见，特别是对于患有严重四头肌挛缩的患者。迄今为止，尚无研究报道胫骨结节近端化可延长伸伸肌机制治疗骨骼成熟患者的严重HPD的有效性。目的：描述一种新颖的综合程序，包括胫骨结节近端，广泛的侧向释放，胫骨结节中和和pa股韧带内侧（MPFL）重建，用于治疗骨骼成熟患者的严重HPD，并报告其早期临床结果。研究设计：案例系列;证据等级：4。方法：从2014年1月至2016年5月，在同一机构对总共43例HPD的连续患者（47膝）进行了手术治疗，并进行了回顾性检查。其中，11例严重原发性HPD的骨骼成熟患者（11膝）接受了综合指标检查。术前和最后一次随访时记录recorded骨追踪的结果。放射学评估包括标准的前后位影像，真实的侧面影像和轴向影像，以及术前和最终随访时全膝关节伸展的计算机断层扫描。在索引程序之前和最终的随访中，使用Kujala功能评分评估主观pa股功能。结果：纳入的11名患者的平均评估时间为34.9个月（范围25-46个月）。术前lateral骨横向移位时的平均膝关节屈曲角度为25°（范围10°-30°）。放射学上，同侧角从术前的73.4°±17.0°改善到术后的–7.1°±5.8°（P <.01），术前pa骨外侧的角度从术前的–65.6°±9.4°有统计学上的显着改善术后6.1°±2.7°（P ＜.01）。术前平均Kujala功能评分为42.9，术后平均Kujala功能评分为95.2（P <.05）。在最后的随访中没有患者报告pa骨脱位复发。结论：包括胫骨结节近端，广泛的侧向释放，胫骨结节中和和MPFL重建在内的新颖的综合程序有效地治疗了患有严重股四头肌挛缩的骨骼成熟患者的外侧HPD。

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