青少年急性髌骨脱位保守治疗与手术修复比较

Conservative therapy versus surgical repair for acute patellar dislocation in adolescents

摘要:

[目的]比较青少年急性髌骨脱位保守与手术治疗的临床效果。[方法]回顾性分析 2014 年—2018 年收治青少年急性髌骨脱位 40 例患者的临床资料。按影像检查有无关节内游离体将患者分为两组，23 例无游离体的患者给予保守治疗，17 例有游离体患者给予手术修复内侧髌股韧带(medial patellofemoral ligament, MPFL)。比较两组患者早期、随访与影像学资料。[结果] 保守组治疗期间无不良反应和并发症；手术组 17 例顺利手术，无血管、神经损伤等严重并发症。两组患者均获随访 3~7 年，平均(4.8±1.1)年。随访过程中，保守组及手术组各有 1 例再次出现髌骨脱位，两组间再脱位率的差异无统计学意义(P＞ 0.05)。与治疗前相比，治疗后 6 个月和末次随访时两组 Kujala 和 Lysholm 评分，以及膝伸-屈 ROM 均显著增加(P＜0.05)。相应时间点，两组 Kujala 评分、Lysholm 评分和膝伸-屈 ROM 的差异均无统计学意义 (P＞0.05)。影像方面，与治疗前相比，末次随访时两组髌骨倾斜角 (patellar title, PT) 及髌骨外移 (patellar displacement, PD) 均显著减小 (P＜0.05)。治疗前两组间 PT 和 PD 的差异均无统计学意义(P＞0.05)。末次随访时，保守组的 PT 和 PD 均显著大于手术组(P＜0.05)。[结论] 青少年急性髌骨脱位保守治疗及手术治疗效果相当，治疗急性髌骨脱位应根据病情制定个性化治疗方案。

Abstract:

[Objective] To compare the clinical outcomes of conservative therapy versus surgical treatment of acute patellar dislocation in adolescents. [Methods] A retrospective study was performed on 40 adolescent patients who received treatment for acute patellar disloca- tion in our department from 2014 to 2018. The patients were divided into two groups according to whether intraarticular loose bodies noted by imaging examination. Of them, 23 patients without intraarticular loose bodies were given conservative therapy, while the other 17 pa- tients with intraarticular loose bodies were given surgical repair of medial patellofemoral ligament (MPFL) . The documents regarding earlystage, follow-up and imaging consequences were compared between the two groups. [Results] In the conservative group, all the 23 patients had no adverse reactions and complications during treatment. In the operation group, all the 17 patients were successfully operated on with- out serious complications such as vascular and nerve injury. Patients in both groups were followed up for 3~7 years, with an average of (4.8± 1.1) years. During the follow-up, 1 patient in the conservative group and 1 patient in the surgery group reoccurred patella dislocation, with- out a significant difference in the redislocation rate between the two groups (P＞0.05) . Compared with those pre-treatment, the Kujala and Lysholm scores, as well as the knee extension and flexion range of motion (ROM) significantly increased in both groups at 6 months after treatment and at the last follow-up (P＜0.05) . However, there were no significant differences in terms of Kujala score, Lysholm score and knee extension and flexion ROM between the two groups at any corresponding time points (P＞0.05) . Regarding imaging, the patellar title (PT) and patellar displacement (PD) significantly reduced in both groups at latest follow-up compared with those preoperatively (P＜0.05) . Although there was no significant difference in PT and PD between the two groups before treatment (P＞0.05) , the conservative group had significantly greater PT and PD than the surgical group at the latest folloe-up (P＜0.05) . [Conclusion] Both conservative therapy and surgi- cal repair achieve satisfactory and comparable clinical outcomes for acute patellar dislocation in adolescents. An individualized treatment plan should be made according to the concrete condition of the patient.