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1、1、原则1.1 显露股骨远端关节面 Exposure of the articular surfaceThe late ral par apatella r app roach pr ovides a good view of the ar ticula r sur face of the distal fem ur. With a longitudinal division of the quad riceps tendon and extens or mechanism, the patella can be dislocated medially.股骨远端外侧髌旁入路提供良好地关节面视野
2、，需要纵向劈开 股四头肌和伸肌装置，髌骨可以向内侧脱位，以增加显露。1.2神经血管特征 Neurovascular structuresIn gen eral, there are no n eurovascular structures at risk. The com mon per on eal n erve is safe posterior and distal to the approach.There is only the lateral superior genicular artery to avoid, or ligate .此处没有神经血管束，腓总神经位于其后方，此处仅
3、有膝上外侧动脉经过，注意 保护或结扎。1.3 神经血管风险 Neurovascular risksThe surgical approach exploits only the exte nsor mecha ni sm. No sig nifica nt n eurovascular risks are prese nt.下图显示横行血管为膝上外侧动脉Popliteal artery_ Saphenous n erveCommon peroneai nerveSuperior lateralI genicular JkJ / arteryarteryTibial nerve-.9Superf
4、icial peroneal n erve;Deep peroneal (nterior tibial) nerve2 髌旁外侧入路的扩展Extensions of the lateral parapatellar approach图中（1）为髌旁外侧入路，可通过（2）来显露股骨干，（3）中间微创显露4、皮肤切 口 Skin incisionPlace a rolled towel under the knee to produce 20 to 30of knee flexion.Mark the tibial tubercle and the patella. The incision ca
5、n be either directly midline, or preferably, slightly lateral to midli ne (as show n).A com mon mistake is to make the in cisi on too short, which will later on not permit medial patellar dislocatio n. The in cisi on is gen erally 15-18 cm in len gth.在 膝下方放置“布卷”以便使膝关节屈曲20-30,标记胫骨结节和髌骨，切口可以选正中切口，也可 稍
6、向外侧直切口，如下图示。经常犯错误为切口不够长，髌骨不能向内侧脱位，一般切口要长约 15-18cm。5、深层分离 Deep dissectionA deep dissecti on exposes the lateral aspect of the patella.The exte nsor retinaculum is preserved over front of the patella.The skin incision is long eno ugh for the surge on to defi ne both the medial and the lateral aspects
7、of the quadriceps tendon. Make a full thick ness, l on gitud inal in cisi on through the lateral parapatellar ret in aculum and the quadriceps tendon .It beg ins slightly lateral to midli ne (40% lateral; 60% medial) and curves to the lateral aspect of the patella. It should leave an 8-10 mm cuff of
8、 parapatellar reti naculum on the lateral aspect of the patella.The split in the quadriceps tendon exte nds approximately 10 cm above the superior pole of the patella. If an adequate release is not performed, the surge on risks patellar tendon avulsi on dur ingpatellar dislocation显露髌骨外侧面及伸肌装置，在膝上，完全
9、显露股四头肌腱，在4： 6比 例处全厚层劈开股四头肌腱，弯向下方，在髌骨外侧面保留& 10mm伸肌装置，以便修复缝合， 切口继续向下方延伸约10cm，如果手术中未充分切开游离髌腱，则在髌骨脱位的时候有造成髌 腱撕脱的风险。6、扩展切口深层分离 Distal extension of the deep dissectionCarry the divisi on dow n distally to the lateral aspect of the patellar tendon and the n, by flexi on of the knee and medial traction on t
10、he extensor mechanism, the patella is dislocated medially. 屈膝，向内侧牵开伸膝装置，髌骨向内侧脱位。7、胫骨结节截骨Tibial tubercle osteotomy知道有就行了，什么时候也不能用.Close the quadriceps tendon and cuff of tissue along the lateral aspect of the patella with interrupted #2, or larger, sutures. Suction drain usage may be considered. Close the skin and subcuta neous tissue in a rout ine ma nn er.修复伸肌装置，放置负压引流管，缝合皮下组织和皮 肤
