大收肌腱移位重建内侧髌股韧带治疗儿童复发性髌骨脱位初期效果分析  

A short-term follow-up study after reconstruction of medial patellofemoral ligament （MPFL） combined with adductor magnus tendon autograft for the treatment of recurrent dislocation of patella（RDP）

作　　者：冯超[1] 王玉琨[1] 张建立[1] 朱振华[1] 郭源[1] 宋猛[1] 

机构地区：[1]北京积水潭医院小儿骨科,北京 100035

出　　处：《中华小儿外科杂志》2012年第6期429-433,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨关节镜辅助下大收肌腱移位重建内侧髌股韧带（medial patellofemoral liga—ment，MPFL）治疗儿童复发性髌骨脱位（recurrent dislocation of patella，RDP）的手术技术和临床效果。方法2008年1月至2010年7月收治了6例RDP（1例为双膝）的患儿，术前进行临床检查、X线片、CT、MRI了解髌股关节及MPFL情况，并进行Lysholm评分，术中先用关节镜观察髌股关节的对合关系、运动轨迹及关节软骨情况，通过髌骨内侧缘切口确定MPFL髌骨止点，并在髌骨内缘制作L形骨髓道，通过股骨内上髁切口显露并游离大收肌腱，移位并穿过髌骨内缘骨髓道，调整张力后反折与自身及髌前腱膜缝合重建MPFL，重建后关节镜检查髌股关节对合关系和运动轨迹恢复情况。同时进行游离体取出和髌外侧支持带松解。对于Q角〉20°或TT-TG＞20mm的病例，同时进行髌腱止点外侧半内移。结果随访12-36个月，平均18个月。所有患儿均未出现髌骨再次脱位，也没有髌骨错动或半脱位的感觉。Lysholm评分由术前平均为76．7±8．7改善为术后95．6±5．7（P=0．000）。结论关节镜辅助下大收肌腱移位重建内侧髌股韧带治疗儿童复发性髌骨脱位初期效果满意，远期效果有待进一步观察。Objective To explore the technique and efficacy of the arthroseopic reconstruction of medial patellofemoral ligament（MPFL） combined with adductor magnus tendon autograft in treatment of recurrent dislocation of patella（RDP） in children. Methods Six cases of RDP were treated using ar- throscopic reconstruction of MPFL combined with adductor magnus tendon autograft beween Jan 2007 to Jul 2010. The condition of patellofemoral joint and MPFL were detected with X-ray, CT and MRI preoperatively. The arthroscopic examination was conducted before reconstruction to observe patel- lofemoral congruence and patellar track, as well as articular cartilage. The MPFL was reconstructed followed by adductor magnus tendon autograft. Then arthroscopic examination was taken again for measurement of patellofemoral congruence and patellar track after surgery. Function training of knee joint was applied and subjective symptoms were further scored postoperatively. Results No infection, graft rejection and rupture were seen in all cases. Patients were followed up for 12-36 months （Aver- age 18 months）. Lysholm scores showed an improvement from 76. 7± 8. 7 in pre-surgery to 95.6 ± 5.7 （P= 0.000）in post-surgery. X-ray detection indicated excellent patella reduction without recurrence of dislocation or subluxaion. Conclusions The reconstruction of medial patellofemoral ligament （MPFL） combined with adductor magnus tendon autograft, is effective approach to treat RDP.

关 键 词：髌骨脱位 髌韧带 关节镜 

分 类 号：R726.8[医药卫生—儿科]