小儿和青少年髌骨股骨不稳:从病因到治疗。

IF 2 4区 医学 Q2 PEDIATRICS Children-Basel Pub Date : 2024-10-18 DOI:10.3390/children11101261
Anthony Ricciuti, Katelyn Colosi, Kevin Fitzsimmons, Matthew Brown
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引用次数: 0

摘要

背景:髌骨不稳是青少年患者最常见的膝关节损伤之一。有几种病理解剖学风险因素需要通过多种方式进行评估,包括X光、磁共振成像(MRI)甚至CT扫描:我们打算回顾这些风险因素以及用于预防复发性脱位的非手术和手术技术:我们对近期有关儿童和青少年髌骨脱位及后续治疗方法的文献进行了广泛的回顾:我们详细回顾了风险因素,如髌骨脱位、胫骨髁发育不良、胫骨结节外侧化或胫骨髁沟内侧化(胫骨结节到胫骨髁沟的距离(TT-TG)增加)、下肢错位、股骨过度内翻和/或胫骨扭转以及过度松弛。脱位者有分类系统,患者通常会经历不稳定性的自然发展过程。只有当患者经过支撑和物理治疗后仍然脱位,才会考虑手术治疗。手术技术各不相同,最常用的是髌股内侧韧带(MPFL)重建术。不过,还有其他多种技术可用于解决其他解剖学风险因素。这些技术包括胫骨结节截骨术,以解决TT-TG距离过大的问题;或蹄状肌成形术,以解决蹄状沟缺乏的问题:结论:针对髌骨脱位患者的非手术和手术治疗应根据每位患者的病理解剖学风险因素量身定制。
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Patellofemoral Instability in the Pediatric and Adolescent Population: From Causes to Treatments.

Background: Patella instability is one of the most common knee injuries in the adolescent patient. There are several pathoanatomic risk factors which should be assessed via several modalities, including X-rays, magnetic resonance imaging (MRI), or even CT scan.

Objectives: We intend to review these risk factors along with the nonsurgical and surgical techniques used to prevent recurrent dislocations.

Methods: We completed an extensive review of the recent literature concerning pediatric and adolescent patellar dislocation and subsequent treatment modalities.

Results: We review in detail the risk factors such as patella alta, trochlear dysplasia, lateralization of the tibial tubercle or medialization of the trochlear groove (increased tibial tubercle to trochlear groove (TT-TG) distance), lower limb malalignment, excessive femoral anteversion and/or tibial torsion, and hyperlaxity. There are classification systems for dislocators, and a natural progression of instability that patients often proceed through. Only after a patient has continued to dislocate after bracing and physical therapy is surgical treatment considered. Surgical techniques vary, with the workhorse being the medial patellofemoral ligament (MPFL) reconstruction. However, there are a variety of other techniques which add onto this procedure to address other anatomic risk factors. These include the tibial tubercle osteotomy to address a large TT-TG distance or trochleoplasty to address the lack of a trochlear groove.

Conclusions: Nonsurgical and surgical treatments for patella dislocators are tailored to the pathoanatomic risk factors in each patient.

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来源期刊
Children-Basel
Children-Basel PEDIATRICS-
CiteScore
2.70
自引率
16.70%
发文量
1735
审稿时长
6 weeks
期刊介绍: Children is an international, open access journal dedicated to a streamlined, yet scientifically rigorous, dissemination of peer-reviewed science related to childhood health and disease in developed and developing countries. The publication focuses on sharing clinical, epidemiological and translational science relevant to children’s health. Moreover, the primary goals of the publication are to highlight under‑represented pediatric disciplines, to emphasize interdisciplinary research and to disseminate advances in knowledge in global child health. In addition to original research, the journal publishes expert editorials and commentaries, clinical case reports, and insightful communications reflecting the latest developments in pediatric medicine. By publishing meritorious articles as soon as the editorial review process is completed, rather than at predefined intervals, Children also permits rapid open access sharing of new information, allowing us to reach the broadest audience in the most expedient fashion.
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