自体腘绳肌腱移植治疗复发性髌骨脱位  

Treatment of recurrent dislocation of patella using autohamstring tendon transplantation

作　　者：王宁[1] 刘玉杰[1] 杨玉明[1] 朱娟丽[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《军医进修学院学报》2009年第5期603-605,共3页Academic Journal of Pla Postgraduate Medical School

基　　金：国家科技支撑计划课题(2006BAK37B09)~~

摘　　要：目的比较不同固定方法自体腘绳肌腱移植重建内侧髌骨韧带（MPFL），治疗复发性髌骨脱位的临床疗效。方法本研究共入选15例（17膝）复发性髌骨脱位的患者，其中女性13例（15膝），男性2例（2膝）。平均年龄25．7岁（15～44岁）。入选病例随机分为两组：Ⅰ组为U形隧道法重建MPFL，Ⅱ组为髌骨内缘缝合固定法重建MPFL。术中根据不同软骨损伤情况行刨削刀打磨及射频汽化修整损伤软骨，髌股外侧支持带松解后采用自体腘绳肌腱移植重建内侧髌骨支持带。关节镜下动态调整移植肌腱在膝关节不同屈伸角度下的张力及运动轨迹，位置满意后髌骨端分别采用U形隧道法（8例10膝）或缝合法（7例7膝）固定；股骨端均采用界面螺钉固定。术前及术后随访时记录Kujala评分及Lysholm评分。结果所有患者术后均获随访，平均34．8个月（8—60个月）。术后Kujala评分U形法平均（73．7±7．04）分，缝合法平均（86．7±7．70）分；Lysholm评分U形法平均（69．0±12．1）分，缝合法平均（80．4±14．3）分。随访期U形法固定组1例发生髌骨下极骨折，1例发生再脱位，骨折经手术治疗后膝关节功能恢复良好。结论关节镜下外侧髌股支持带松解与腘绳肌腱移植重建内侧髌股韧带治疗复发性髌骨脱位疗效可靠，缝合固定法创伤小，操作简便，费用低廉，易于推广。Objective To compare the therapeutical effects of different reconstruction methods to fix medial patellofemoral ligament（MPFL） using autohamstring tendon graft on recurrent dislocation of patella. Methods Fifteen patients [13 females （15 knees）, 2 males （2 knees）] with recurrent dislocation of patella were included in this study. Their average age was 25.7 years （15- 44 years）. The patients were randomly divided into 2 groups. Medial patella ligament reconstruction was performed for patients in groups 1 and 2 by U-shaped bone tunnel fixation and suture fixation, respectively. During the operation, the injured cartages were polished with knife or trimed with radiofrequency gasfication according to their severity. The latemal patella and femur supporting ligaments were relaxed and the medial patella ligament was reconstructed using autohamstring tendon graft. Kujala and Lysholm score were recorded before and after operation. Results All the patients were followed up for an average period of 34.Smonths（8-60 months）. The postoperative Kujala score for the two groups was 73.7 ± 7.04 and 86.7 ± 7.70, respectively（P〈0.05）. The postoperative Lysholm score for the two groups was 69.0 ± 12.1 and 80.4 ± 14.3, respectively （P〉0.05）. One case of fracture in patella inferior pole and lcase of redislocation were observed in group I during the fellow-up. The function of knee joints recovered quite well after operation. Conclusion Reliable therapeutic effects can be achieved in the treatment of recurrent dislocation of patella by relaxing the lateral and reconstructing the medial patella and fermur supporting ligaments using hamstring tendon graft, The method results in small wounds, is simple to perform and popularized, with low costs.

关 键 词：关节镜检查 髌韧带 膝脱位 

分 类 号：R684[医药卫生—骨科学]