青少年急性髌骨脱位的治疗篇章及研究进展

杨 佳乐1, 李 超*2
1、青海大学
2、青海大学附属医院

摘要


急性髌骨脱位是膝关节损伤中常见的一种疾病，也是青少年中一种常见且复杂的膝关节损伤。发生急性髌骨脱位有多种因素，除了创伤性因素外，骨性因素也是发生急性髌骨脱位的常见诱因。大多数急性髌骨脱位可以通过非手术治疗，即保守治疗；但近年来研究表明保守治疗面临着较高的再脱位率。随着运动医学的不断发展和对髌骨脱位认识的不断加深，越来越多学者提倡手术治疗，但对于手术方式的选择以及手术所带来的相关并发症考虑尚未达成共识。本文对急性髌骨脱位的治疗进展及相关问题做一综述，为临床医师选择治疗方案提供参考。

关键词


青少年；急性髌骨脱位；治疗

全文:

PDF


参考


[1]Diduch D, Laidlaw M. Current concepts in the management of patellar instability [J ]. Indian J Orthop, 2017, 51 (5) : 493.

[2]Sanders TL,Pareek A, Hewett TE, et al. Incidence of first-time lateral patellar dislocation: a 21-year population-based study [J]. Sports Health, 2018, 10 (2): 146-151.

[3]Camanho GL, Viegas Ade C, Bitar AC, Demange MK, Hernandez AJ (2009) Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy 25:620-625

[4]Nwachukwu BU, So C, Schairer WW, Green DW, Dodwell ER (2016) Surgical versus conservative management of acute patellar dislocation in chil-dren and adolescents: a systematic review. Knee Surg Sports Traumatol Arthrosc 24:760-767.

[5]Moström EB, Mikkelsen C, Weidenhielm L, Janarv PM. Long-term follow-up of nonoperatively and operatively treated acute primary patellar dislocation in skeletally immature patients. ScientificWorldJournal. 2014;2014:473281.

[6]Parikh SN, Schlechter JA, Veerkamp MW, et al. Consensus-based guidelines for management of first-time patellar dislocation in adolescents[J]. J Pediatr Orthop, 2024, 44(4): e369-e374.

[7]Smith TO, Gaukroger A, Metcalfe A, et al. Surgical versus nonsurgical interventions for treating patellar dislocation[J]. Cochrane Database Syst Rev, 2023, 1(1): CD008106.

[8]Smith TO, Song F, Donell ST, Hing CB. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surgery, Sports Traumatology, Arthroscopy2011;19(6):988-98.

[9]Becher, C.; Schumacher, T.; Fleischer, B.; Ettinger, M.; Smith, T.; Ostermeier, S. The effects of a dynamic patellar realignment brace on disease determinants for patellofemoral instability in the upright weight-bearing condition. J. Orthop. Surg. Res. 2015, 10, 126.

[10]Dejour DH, Mesnard G, Giovannetti de Sanctis E. Updated treat-ment guidelines for patellar instability: “un menu à la carte.” J Exp Orthop 2021:8:109.

[11]Stefancin JJ, Parker RD. First-time traumatic patellar dis-location: a systematic review. Clin Orthop Relat Res.2007;455:93-101.

[12]Nwachukwu BU, So C, Schairer WW, et al. Surgical versus conservative management of acute patellar dislocation in children and adolescents: a systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2016, 24(3): 760-767.

[13]Honkonen EE, et al. A randomized controlled trial compar-ing a patella-stabilizing, motion-restricting knee brace versus a neoprene nonhinged knee brace after a first-time traumatic patellar dislocation. Am J Sports Med. 2022;50(7):1867-1875.

[14]Frings J, Balcarek P, Tscholl P, Liebensteiner M, Dirisamer F, Koenen P. Conservative Versus Surgical Treatment for Primary Patellar Dislocation. Dtsch Arztebl Int. 2020 Apr 17;117(16):279-286.

[15]Le N, Blackman B, Zakharia A, Cohen D, de Sa D. MPFL repair after acute first-time patellar dislocation results in lower redislocation rates and less knee pain compared to rehabilitation: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2023 Jul;31(7):2772-2783.

[16]Liu Z, Yi Q, He L, Yao C, Zhang L, Lu F, Zhang X, Wu M, Geng B, Xia Y, Jiang J. Comparing Nonoperative Treatment, MPFL Repair, and MPFL Reconstruction for Patients With Patellar Dislocation: A Systematic Review and Network Meta-analysis. Orthop J Sports Med. 2021 Sep 28;9(9):23259671211026624.

[17]Previtali D, Milev SR, Pagliazzi G, et al. Recurrent patellar dislocations without untreated predisposing factors: medial patellofemoral ligament reconstruction versus other medial soft-tissue surgical techniques-a meta-analysis[J]. Arthroscopy, 2020, 36(6): 1725-1734.

[18]Husen M, Milbrandt TA, Shah V, Krych AJ, Stuart MJ, Saris DBF. Medial Patellofemoral Ligament Reconstruction Using Allografts in Skeletally Immature Patients. Am J Sports Med. 2023 May;51(6):1513-1524.

[19]Balcarek, P.; Walde, T.A.; Frosch, S.; Schüttrumpf, J.P.; Wachowski, M.M.; Stürmer, K.M.; Frosch, K.H. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy. Eur. J. Radiol. 2011, 79, 415-420.

[20]Nelitz M, Dreyhaupt J, Williams SRM. No Growth disturbance after trochleoplasty for recurrent patellar dislocation in adolescents with open growth plates[J]. Am J Sports Med, 2018, 46(13): 3209-3216.

[21]Franciozi CE, Ambra LF, Albertoni LJB, Debieux P, Granata GSM Jr, Kubota MS, Carneiro M, Abdalla RJ, Luzo MVM, Cohen M. Anteromedial Tibial Tubercle Osteotomy Improves Results of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients With Tibial Tuberosity-Trochlear Groove Distance of 17 to 20 mm. Arthroscopy. 2019 Feb;35(2):566-574.

[22]王雪松，张志军，张辉.股骨远端去旋转截骨术联合内侧髌股韧带重建治疗伴股骨前倾角增大的复发性髌骨脱位的中期临床疗效[J].中国运动医学杂志，2022，41（07）：499-503.

[23]Hinz M, Cotic M, Diermeier T, et al. Derotational distal femoral osteotomy for patients with recurrent patellar instability and increased femoral antetorsion improves knee function and adequately treats both torsional and valgus malalignment[J]. Knee Surg Sports Traumatol Arthrosc, 2022.


Refbacks

  • 当前没有refback。