PDF(Pubmed)
Abstract：
UNASSIGNED: Patellar instability and dislocation pose complex clinical and surgical challenges, especially in children. Congenital (fixed) and obligatory (habitual) dislocations present significant anatomical and etiological complexity, frequently leading to deformities and functional impairments, which can range from walking difficulties to sports limitations. Conservative treatment is often inadequate.
UNASSIGNED: We describe a surgical technique for treating congenital or obligatory patellar dislocations in patients with various underlying diagnoses-including Down syndrome, nail-patella syndrome, and skeletal dysplasia-that involves extensive subperiosteal quadriceps realignment, distal realignment (Roux-Goldthwait or tibial tuberosity transfer), and optional medial plication. This modified 4-in-1 technique follows the principles described in 1976 by Stanisavljevic, which involves subperiosteal quadriceps mobilization, thus minimizing muscle damage, bleeding, and postoperative muscular adherences.
UNASSIGNED: In 24 patients treated at our institution between 2002 and 2021 (35 knees; age range = 5.5-16.8 years; 13 girls, 11 boys), with a mean follow-up of 8.2 years (2.4-20 years), we achieved satisfactory improvements in patellar stability, range of motion, and quality of life with a modified 4-in-1 Stanisavljevic technique. A total of 9 patients (7 with obligatory dislocations and 2 with congenital dislocations) could engage in recreational or competitive sports. The average postoperative pediatric International Knee Documentation Committee (pedi-IKDC) score was 78.45 ± 22.3 (range = 0-100); a patient with DiGeorge syndrome and 1 with multiple epiphyseal dysplasia had scores of 35 and 48, respectively.
UNASSIGNED: We found at our institution that a modified 4-in-1 Stanisavljevic technique produced favorable outcomes in patellar stability, range of motion, and quality of life in pediatric patients with congenital or obligatory patellar dislocation. More study is warranted to determine the procedure\'s overall benefits for children with obligatory or congenital dislocations of complex etiology.
UNASSIGNED: We describe a surgical technique for treating congenital or obligatory patellar dislocations in patients with various underlying diagnoses-including Down syndrome, nail-patella syndrome, and skeletal dysplasia-that involves extensive subperiosteal quadriceps realignment, distal realignment (Roux-Goldthwait or tibial tuberosity transfer), and optional medial plication. This modified 4-in-1 technique follows the principles described in 1976 by Stanisavljevic, which involves subperiosteal quadriceps mobilization, thus minimizing muscle damage, bleeding, and postoperative muscular adherences.
UNASSIGNED: In 24 patients treated at our institution between 2002 and 2021 (35 knees; age range = 5.5-16.8 years; 13 girls, 11 boys), with a mean follow-up of 8.2 years (2.4-20 years), we achieved satisfactory improvements in patellar stability, range of motion, and quality of life with a modified 4-in-1 Stanisavljevic technique. A total of 9 patients (7 with obligatory dislocations and 2 with congenital dislocations) could engage in recreational or competitive sports. The average postoperative pediatric International Knee Documentation Committee (pedi-IKDC) score was 78.45 ± 22.3 (range = 0-100); a patient with DiGeorge syndrome and 1 with multiple epiphyseal dysplasia had scores of 35 and 48, respectively.
UNASSIGNED: We found at our institution that a modified 4-in-1 Stanisavljevic technique produced favorable outcomes in patellar stability, range of motion, and quality of life in pediatric patients with congenital or obligatory patellar dislocation. More study is warranted to determine the procedure\'s overall benefits for children with obligatory or congenital dislocations of complex etiology.
摘要：
■髌骨不稳定和脱位构成了复杂的临床和手术挑战，尤其是儿童。先天性（固定）和强制性（习惯性）脱位表现出显著的解剖学和病因学复杂性，经常导致畸形和功能障碍，从行走困难到运动限制。保守治疗往往是不够的。
■我们描述了一种手术技术，用于治疗患有各种潜在诊断的患者的先天性或强制性髌骨脱位，包括唐氏综合征，指甲髌骨综合征,和骨骼发育不良-涉及广泛的骨膜下四头肌重新对准，远端重新对齐（Roux-Goldthwait或胫骨结节转移），和可选的内侧折叠。这种改进的4合1技术遵循Stanisavljevic在1976年描述的原理，涉及骨膜下四头肌动员，从而最大限度地减少肌肉损伤，出血,和术后肌肉粘附。
■在2002年至2021年之间在我们机构接受治疗的24名患者中（35个膝盖；年龄范围=5.5-16.8岁；13名女孩，11个男孩），平均随访8.2年(2.4-20年)，我们在髌骨稳定性方面取得了令人满意的改善，运动范围,使用改良的4合1Stanisavljevic技术改善生活质量。共有9例患者（7例强制性脱位，2例先天性脱位）可以从事休闲或竞技运动。术后儿科国际膝关节文献委员会（pedi-IKDC）的平均评分为78.45±22.3（范围=0-100）；患有DiGeorge综合征的患者和1例多发性骨骨发育不良的患者的评分分别为35和48。
■我们在我们的机构发现，改良的4合1Stanisavljevic技术在髌骨稳定性方面产生了良好的结果，运动范围,先天性或强制性髌骨脱位患儿的生活质量。有必要进行更多的研究，以确定该手术对病因复杂的强制性或先天性脱位儿童的总体益处。
■我们描述了一种手术技术，用于治疗患有各种潜在诊断的患者的先天性或强制性髌骨脱位，包括唐氏综合征，指甲髌骨综合征,和骨骼发育不良-涉及广泛的骨膜下四头肌重新对准，远端重新对齐（Roux-Goldthwait或胫骨结节转移），和可选的内侧折叠。这种改进的4合1技术遵循Stanisavljevic在1976年描述的原理，涉及骨膜下四头肌动员，从而最大限度地减少肌肉损伤，出血,和术后肌肉粘附。
■在2002年至2021年之间在我们机构接受治疗的24名患者中（35个膝盖；年龄范围=5.5-16.8岁；13名女孩，11个男孩），平均随访8.2年(2.4-20年)，我们在髌骨稳定性方面取得了令人满意的改善，运动范围,使用改良的4合1Stanisavljevic技术改善生活质量。共有9例患者（7例强制性脱位，2例先天性脱位）可以从事休闲或竞技运动。术后儿科国际膝关节文献委员会（pedi-IKDC）的平均评分为78.45±22.3（范围=0-100）；患有DiGeorge综合征的患者和1例多发性骨骨发育不良的患者的评分分别为35和48。
■我们在我们的机构发现，改良的4合1Stanisavljevic技术在髌骨稳定性方面产生了良好的结果，运动范围,先天性或强制性髌骨脱位患儿的生活质量。有必要进行更多的研究，以确定该手术对病因复杂的强制性或先天性脱位儿童的总体益处。
