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首页> 外文期刊>Knee surgery, sports traumatology, arthroscopy: official journal of the ESSKA >Medial patellofemoral ligament (MPFL) reconstruction technique using an epiphyseal femoral socket with fluoroscopic guidance helps avoid physeal injury in skeletally immature patients
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Medial patellofemoral ligament (MPFL) reconstruction technique using an epiphyseal femoral socket with fluoroscopic guidance helps avoid physeal injury in skeletally immature patients

机译：使用具有荧光镜引导的骨骺股骨插座的内侧髌骨型韧带（MPFL）重建技术有助于避免骨骼未成熟患者的性能损伤

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Purpose The purpose of this study was to assess the physeal safety associated with the use of an epiphyseal femoral socket for paediatric medial patellofemoral ligament (MPFL) reconstruction. Methods Fifty-four knees in 49 skeletally immature patients underwent physeal-sparing MPFL reconstruction performed by 1 surgeon at a tertiary care academic medical centre from 2007 to 2016. A femoral socket distal to the femoral physis was used for graft fixation in all the patients. To assess physeal safety, all included patients either had post-operative MRIs of the operative knee or standing hip-to-ankle radiographs. Physeal safety was assessed on MRI, and the distance between the femoral socket relative to the physis was measured at both the aperture and the end of the socket. Development of lower limb angular deformities and/or limb length discrepancy (LLD) was evaluated using post-operative standing hip-to-ankle radiographs, patient records, and clinical assessments. Results The mean age at time of surgery was 13.3 +/- 1.6 years. The median length of radiographic follow-up was 2.2 years (range 1.0-5.7 years). At most recent clinical follow-up, five patients (9.3%) had recurrent patellar instability, with three patients (5.6%) undergoing subsequent tibial tubercle osteotomy or revision MPFL reconstruction. There was no statistically significant difference in leg length between operated and non-operated extremities (n.s.). There was no statistically significant difference between non-operated and operated mMPTA (n.s.) and mLDFA (n.s.) measurements. On post-operative MRI, there was no evidence of physeal arrest. The median distance from the physis to the socket at the aperture and distal end of the femoral socket were 5.9 mm (range 1.9-12) and 7.1 mm (1.3-12.4), respectively. Conclusion These results demonstrate that with fluoroscopic guidance, placing the femoral socket distal to the distal femoral physis is an effective method for avoiding physeal injury and subsequent growth disturbances in children with patellar instability. Clinically, this information is essential in optimal surgical management of these patients, as this technique allows for femoral fixation of the MPFL reconstruction graft within the epiphysis while also preserving normal growth.
机译：目的本研究的目的是评估与使用骨骺股骨插座进行的性能安全，用于儿科内侧髌韧带韧带（MPFL）重建。方法49次骨折患者54膝膝关节接受了50岁的患者在2007年至2016年的第三级护理学术医疗中心进行的Sheary Sparing MPFL重建。对股骨生物体远端的股骨插座用于所有患者的接枝固定。为了评估性能安全，所有包括患者的手术膝关节的术后MRIS或常设髋关节射脊片。在MRI上评估身体安全，并在插座的孔径和末端测量相对于物质的股骨窝之间的距离。使用术后阶段的髋关节到踝X线本，患者记录和临床评估，评估下肢角度畸形和/或肢体长度差异（LLD）的研制。结果手术时的平均年龄为13.3 +/- 1.6岁。射线照相随访的中位数为2.2年（1.0-5.7岁）。在最近的临床随访中，五名患者（9.3％）具有复发性髌骨不稳定性，三名患者（5.6％）接受后续胫骨节结节骨质切断或修订MPFL重建。在操作和非操作的四肢（N.S.）之间没有统计学上显着的腿部差异。非操作和操作的MMPTA（N.S.）和MLDFA（N.S.）测量没有统计学上的显着差异。在术后MRI上，没有物理逮捕的证据。从股骨头和股骨插座的孔径和远端的插座的中位距离分别为5.9 mm（1.9-12）和7.1mm（1.3-12.4）。结论这些结果表明，随着荧光透视引导，将股骨插座放置在远端股骨生理学中，是避免髌骨不稳定性的儿童的生理损伤和随后的生长干扰的有效方法。临床上，这些信息对于这些患者的最佳手术管理至关重要，因为这种技术允许在骨骺内的MPFL重建移植物的股骨固定，同时保持正常生长。

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