半隧道骨桥固定和锚钉缝合固定双束解剖重建内侧髌股韧带治疗髌骨脱位的临床研究  

Fixation by semi-tunnel bone bridge versus suture anchors in double-bundle anatomic reconstruction of the medial patellofemoral ligament for treatment of patellar dislocation

作　　者：王浩宇[1] 王成海[1] 王飞[1] 马龙飞[1] 周建伟[1] 纪刚[1] 

机构地区：[1]河北医科大学第三医院关节一科,石家庄050051

出　　处：《中国矫形外科杂志》2013年第16期1607-1612,共6页Orthopedic Journal of China

摘　　要：[目的]对比观察半隧道骨桥固定和锚钉缝合固定双束解剖重建内侧髌股韧带治疗髌骨脱位的临床效果。[方法]回顾性研究自2006年3月～2008年4月在本院治疗的髌骨脱位患者共81例(81膝)。男29例,女52例,年龄16～26岁,平均20.4岁。半隧道骨桥固定重建组45例(45膝),锚钉缝合固定重建组36例(36膝)。术后随访记录发生髌骨再脱位的病例数。手法检查髌骨外推恐惧试验及髌骨稳定性。以Kujala膝关节评分和主观问卷评分进行膝关节功能评分。术后随访行CT扫描,并测量髌骨外移率及髌骨倾斜角。应用SPSS 13.0统计学软件包分析随访数据。[结果]术后所有伤口均Ⅰ期愈合。所有患者均获得随访,随访时间24、48个月。术后两组均无髌骨再脱位发生,髌骨外移率及髌骨倾斜角均恢复至正常范围,与术前相比差异具有统计学意义。膝关节Kujala评分:半隧道骨桥固定重建组术前为(57.09±2.59)分,术后24个月(92.91±3.18)分,术后48个月(93.67±1.80)分;锚钉缝合固定重建组术前(56.19±2.78)分,术后24个月(91.72±2.99)分,术后48个月(92.58±2.09)分。髌骨外移率(patellar lateral shift ratio,PLSR)、髌骨倾斜角(patella tilt angle,PTA)及膝关节Kujala评分术后24个月两组间差异均无统计学意义,而术后48个月两组间具有显著差异(P<0.05)。[结论]半隧道骨桥固定和锚钉缝合固定两种术式双束解剖重建内侧髌股韧带均可以有效恢复髌骨稳定性,提高膝关节功能,改善患者生活质量,两者短期临床效果相当,长期临床效果半隧道骨桥固定术优于锚钉缝合固定术。[ Objective] To compare clinical results of double-bundle anatomic reconstruction of the medial patellofemoral ligament with fixation of semi-tunnel bone bridge and suture anchors for treatment of patellar dislocation. [ Method] This study reviewed 81 patients who had undergone double-bundle anatomic reconstruction of the medial patellofemoral ligament to treat pa- tellar dislocation from March 2006 to April 2008, including 29 men and 52 women, aged from 16 to 26 years old with an average age of 20.4 years. The modified semi-tunnel bone bridge fixation was used in 45 patients and suture anchors fixation was used in the remaining 36 patients. Complications in both groups were recorded. The clinical evaluation involved physical examination and patellar apprehension sign,patellar stability, Kujala scores and subjective questionnaire scores. Computerized tomography （CT） were conducted d to evaluate the patellar lateral shift ratio （PLSR） and the patella tilt angle （PTA）. SPSS 13.0 statistical soft- ware was used to analyse the follow-up data. [ Result j The wound of all the patients healed primarily. All of the patients were followed up at 24 months and 48 months. No patellar re-dislocation occurred. PLSR and PTA were restored to the normal range, with a statistically significant difference compared with the preoperative data （P 〈 0.05）. At 24 months postoperatively, the Ku- jala scores in semi-tunnel bone bridge group were significantly improved from 57.09 ± 2.59 preoperatively to 92.91 ± 3.18 postoperativly （ P 〈 0. 05 ）, likewise, those were also significantly increased from 56.19 ± 2.78 preoperatively to 91.72 ± 2.99 postoperatively in suture anchors group （P 〈 0.05 ）, however, there was no significant difference in Knjala scores between the two groups. At 48 months postoperatively, Kujala scores 93.67 ± 1.80 in semi-tunnel bone bridge group were significantly higher than 92.58 ± 2.09 in suture anchors group （P 〈 0.05）. Similar differences in PLSR and PTA were found betwe

关 键 词：髌骨脱位 半隧道骨桥固定 锚钉缝合固定 内侧髌股韧带 解剖重建 

分 类 号：R687.3[医药卫生—骨科学]