儿童首次创伤性髌骨脱位后膝关节支具治疗与内侧髌股韧带手术修复的长期结果：从骨骼未成熟到成年的10年随访
简介
该研究对74例首次创伤性髌骨脱位（FTPD）的儿童患者进行10年随访，比较初始膝支具治疗（KB组，n=25）与MPFL修复（n=21）的远期效果。主要发现：KB组再脱位率（80%）高于MPFL修复组（62%），但差异无统计学意义（P=0.175）；早期再脱位（≤2年）KB组更多（52% vs 29%），晚期（>2年）两组相似（28% vs 33%）；再脱位患…
英文摘要
BACKGROUND: Optimal management of first-time traumatic patellar dislocation (FTPD) in pediatric patients remains disputed. Nonoperative treatment avoids surgical risks and may be optimal for select patients, whereas operative medial patellofemoral ligament (MPFL) repair aims to prevent recurrent instability and reduce redislocation in the short term. PURPOSE: To compare the redislocation rate, subsequent surgical intervention, and subjective knee function between pediatric patients initially treated with a knee brace (KB) and those who underwent operative MPFL repair. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: This 10-year follow-up study of 74 participants from a previously conducted randomized controlled trial included 46 patients (62%) available for reassessment (KB, n = 25; MPFL repair, n = 21). The primary outcomes, redislocation and subsequent knee surgery, were collected from questionnaires and medical records. Subjective knee function was measured using the Knee injury and Osteoarthritis Outcome Score for children (KOOS-Child), Kujala Anterior Knee Pain Scale, and Tegner Activity Score. Key anatomic risk factors were taken from magnetic resonance imaging scans at baseline. Group comparisons were performed at 10-year follow-up. RESULTS: The KB group demonstrated a higher overall redislocation rate (80%) compared with the MPFL repair group (62%), although the difference was not statistically significant (P = .175). Early redislocations (≤2 years) were more frequent in the KB group (52% vs 29%; P = .108), whereas rates for late (>2 years) redislocations (28% vs 33%) were similar. Among patients with redislocation, 45% (KB) and 54% (MPFL repair) underwent subsequent knee surgery. Surgery occurred earlier in the KB group (a mean of 25 vs 62 months). Long-term functional scores were similar between groups. However, patients who sustained any redislocation reported significantly lower KOOS-Pain, KOOS-Quality of Life, and Kujala scores than those who remained stable. Anatomic patellar instability factors were common in both groups. CONCLUSION: The long-term redislocation rate in FTPD for patients with MPFL repair was nearly as high as for patients treated nonoperatively. Subjective knee function was comparable between the 2 treatments. Given the high rate of recurring instability in children, the authors do not support routine MPFL repair for FTPD, nor do they support nonoperative treatment as the gold standard for every child. However, when nonoperative treatment is used, a structured follow-up should be mandatory.