The Clinical Research on the Treatment of Fixed External Dislocation of Patella by Femoral Pulley Blow Shaping Combined with Distal and Distal Rearrangement of Patella
Objective:To investigate the clinical efficacy of the treatment of fixed external dislocation of patella with severe femoral trochlear dysplasia by femoral pulley blow shaping combined with proximal and distal rearrangement of patella(lateral patellofemoral ligament release,medial patellofemoral ligament reconstruction,tibial tuberosity inward).Methods:The clinical data of 13 patients diagnosed as fixed external patellar dislocation with severe femoral trochlear dysplasia from January 2019 to January 2022 were retrospectively analyzed.The patients in this group were 6 males and 7 females,with an average age of(22.9±1.2)years old,all of the patients had received the treatment of femoral pulley blow shaping combined with proximal and distal rearrangement of patella.The measurement of femoral trochlear angle(SA),fit angle(CA),lateral displacement of patella(LD),distance between tibial nodule and trochlear groove of femur(TT-TG),Caton-Deschamps index by X-ray and CT were compared before and after surgery.The Lysholm knee function scores and Kujala patellofemoral instability symptom scores were compared be-fore and after surgery.Results:All patients in this group were followed up by 1-3 years,mean(1.6±0.2)years.The postoperative wounds were well-healed,without infection,vascular and nerve injury and other complications.The postoper-ative quality of life of these patients were significantly improved,and patellar dislocation of the affected limbs did not occur again.MRI showed no obvious femoral trochlear cartilage injury,shedding and necrosis 1 year after surgery.The measure-ments of SA angle,CA angle,LD,TT-TG and Caton-Deschamps index by X-ray and CT 1 year after surgery had returned to the normal range,which were significantly lower than that before surgery,and the differences were statistically signifi-cant(P＜0.05).The Lysholm scores of knee function increased from(54.60±5.22)points before surgery to(82.60± 2.70)points 1 year after surgery,and the Kujala symptom scores of patellofemoral instability increased from(54.20± 8.04)points before surgery to(81.60±3.97)points 1 year after surgery,and the differences were statistically significant(P＜0.05).Conclusion:For patients with fixed external patellar dislocation with severe femoral trochlear dysplasia,the femoral chlea groove can be effectively reconstructed by femoral pulley blow shaping,and the operation is simple and no special tools are needed.Combined with proximal and distal rearrangement of patella,it can effectively correct the motion trajectory of patellofemoral joint and improve the function of knee joint.It has good clinical efficacy in the short and medi-um term and is worthy of further study.
femoral pulley blow shapingfixed external dislocation of patellafemoral trochlear dysplasiaproximal and distal rearrangement of patella
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