Chinese Journal of Tissue Engineering Research ›› 2013, Vol. 17 ›› Issue (18): 3413-3420.doi: 10.3969/j.issn.2095-4344.2013.18.025
Zhu Jun, Zhu Yun-li, Wu Hai-shan, Wu Yu-li, Fu Pei-liang
Received:
2012-12-29
Revised:
2013-02-25
Online:
2013-04-30
Published:
2013-04-30
Contact:
Zhu Yun-li, Doctor, Associate chief physician, Department of Joint Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China
joint_zhu@126.com
About author:
Zhu Jun☆, Doctor, Attending physician, Department of Joint Surgery, Shanghai Changzheng Hospital, Shanghai 200003, China
xlgy1@sina.com
CLC Number:
Zhu Jun, Zhu Yun-li, Wu Hai-shan, Wu Yu-li, Fu Pei-liang. Recurrent patellar dislocation in children treated with different soft tissue transplantation: A comparative study[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(18): 3413-3420.
2 文章分析结果与其他研究结果的比较 2.1 资料来源 检索数据库有关软组织移植治疗儿童复发性髌骨脱位的文献[26-27],研究文献范围1990至2011年,检索词为“软组织移植(Soft tissue transplantation);复发性髌骨脱位(Recurrent patellar dislocation);髌韧带(Patellar tendon);髌股韧带(Patellofemoral ligament);髌骨高位(Patellar high);软组织挛缩(Soft tissue contracture);膝关节脱位(The knee joint dislocation)”,检索到相关文献37篇,结果分析相关文献12篇[5-16]。 2.2 纳入标准 ①股骨远端、胫骨近端骨骺未闭。②移植前均为复发性髌骨脱位。 2.3 排除标准 ①既往有髌骨不稳外科治疗史。②严重高位髌骨、滑车发育不良等发育异常。③单纯髌骨不稳患者,无脱位史。④移植后出现感染、血管、神经损伤等并发症。 2.4 分析指标 ①不同软组织移植物治疗儿童复发性髌骨脱位的效果。②软组织移植对儿童复发性髌骨脱位髌股关节适应性的影响。③软组织移植后早期康复训练对治疗儿童复发性髌骨脱位的中期疗效影响。 2.5 软组织移植治疗儿童复发性髌骨脱位的远期随访效果分析 儿童复发性髌骨脱位是临床上比较常见的膝关节损伤,严重影响患者的运动能力和日常生活。治疗儿童复发性髌骨脱位的方法很多,其目的都是为了控制髌骨不稳,恢复髌骨的正常运动轨道[28]。近年来,随着软组织移植相关研究的深入,软组织移植治疗儿童复发性髌骨脱位取得了良好的临床效果,多数文献报道的移植后成功率很高,主要区别在于所使用的软组织移植物和固定的方法[29]。应用不同来源软组织移植治疗儿童复发性髌骨脱位相关研究分析,见表3。"
2.6 软组织移植对儿童复发性髌骨脱位髌股关节适应性的影响 儿童复发性髌骨脱位的病理改变为股骨滑车窝发育低平、股内侧肌萎缩、内侧髌股韧带薄弱,经常合并有高位髌骨等异常解剖形态[34]。由于儿童骨骺及生长板的存在,对于儿童复发性髌骨脱位的治疗主要为软组织移植,并且取得了较好的效果,但是对于移植后髌股关节适应性相关报道较少[35]。吕学敏等[36]研究了软组织移植治疗不同年龄段儿童复发性髌骨脱位后,髌股关节适应性的变化情况。对24例患者行软组织移植治疗,患者年龄平均5.4岁(3-8岁),男6例,女18例,移植前及随访中分别行髌骨轴位和侧位X射线片检查,测量股骨滑车角、髌骨-滑车适配角及髌骨倾斜角的变化情况,以评价髌股关节适应性,相关指标测量结果,见表4。"
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