自体半腱肌腱游离移植重建内侧支持带治疗复发性髌骨脱位  

Lateral retinaculum patellae solution and medial patellofemoral ligament reconstruction using the semitendinosus tendon free grafted for the treatment of recurrent dislocation of the patella

作　　者：刘玉杰[1] 薛静[1] 周密[1] 李众利[1] 王志刚[1] 李海鹏[1] 蔡谞[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华骨科杂志》2006年第8期509-512,共4页Chinese Journal of Orthopaedics

摘　　要：目的探讨关节镜下外侧髌股支持带松解和自体肌腱游离移植重建内侧髌股支持带治疗复发性髌骨脱位的疗效。方法复发性髌骨脱位18例,男6例,女12例。年龄17～24岁,平均20岁。关节镜下软骨Ⅳ度损伤者7例采用刨削打磨后微骨折术,软骨损伤Ⅱ度6例和Ⅲ度5例采用射频气化清理。外侧髌股支持带充分松解后,采用自体半腱肌腱游离移植重建内侧髌股支持带,关节镜下动态调整移植肌腱在不同角度下屈伸活动时的张力和髌骨运动轨迹,观察股骨滑车与髌骨的对应关系。采用可吸收界面螺钉将肌腱端固定于股骨内收肌结节的骨道内。结果所有患者术后均获随访,平均13个月(9～19个月)。术后膝关节稳定性增加,无髌骨再脱位发生。恐惧试验阴性,髌骨倾斜试验对称,髌股关节研磨试验阴性16例,阳性2例。1例术后髌骨下极骨折,经手术后功能恢复正常。髌骨轴位X线片和MRI显示髌股关节解剖关系恢复正常15例,髌骨轻度半脱位3例。Lysholm评分术前平均(78.0±4.5)分,术后(94.0±3.5)分。结论关节镜下外侧髌股支持带松解与自体肌腱游离移植重建内侧髌股支持带治疗复发性髌骨脱位,方法简便,对于维持髌骨的运动轨迹具有重要作用。Objective To investigate the outcomes of anhroscopically lateral retinaculum patellae release and medial patellofemoral ligament reconstruction using the semitendinosus tendon autograft for the treatment of habitual or recurrent dislocation of the patella. Methods 18 cases of recurrent dislocation of the patella were included in this group, among which there were 6 males and 12 females. The average age was 20 years old （range from 17 to 24 years）. Arthroscopic investigation found tensed lateral retinaeulum patellae and damaged cartilage at patellar medial margin and femoral lateral condyle. There were 6 eases of Ⅱ degree cartilage injuries, 5 cases of Ⅲ degrees injuries, and 7 cases of Ⅳ degree injuries caused by patellofemoral joint impact. For cases of Ⅳ degree injuries, the damaged cartilage was shaved and microfractured. For cases of Ⅱ or Ⅲ degree injuries, radiofrequency system was used for debridement. After the lateral retinaculum patellae was extensively released, semitendinosus tendon autograft was used to reconstruct the medial patellofemoral ligament. The knee joint was flexed and extended. Patella＇s dynamic motion, the tension of the tendon and relationship between the femoral trochlea and patellar bone were arthroscopically observed. Interface screw was used to fix the tendon ends within the bone tunnel on condylus medialis femoris. Results All patients were followed up for 9 to 19 months averaging 13 months. No patellar dislocation occurred postoperatively. Apprehensive test, patella tilt test were negative; and Apley test were negative in 16 patients and positive in 2 patients. One case of inferior pole of patella fractured. Axial view of X- ray and MR images of patella showed 15 cases regained normal anatomical relation of patellofemoral joint. 3 cases had mild semi-dislocation. Lysholm＇s score averaging （78.0±4.5） points preoperatively and （94.0±3.5） points postoperatively. Conclusion Lateral retinaculum patellae solution and medial part reconstruction under arthrosc

关 键 词：关节镜检查 髌骨脱位 膝关节 

分 类 号：R687.4[医药卫生—骨科学]