治疗成年人重度习惯性髌骨脱位的新方法:以胫骨结节近端移位术为核心的“四合一”联合手术  

Tibial Tubercle Proximalization,A Novel Technique to Lengthen the Extensor Mechanism in Adult Patients with Habitual Patellar Dislocation

作　　者：宋关阳[1] 张辉[1] 冯华[1] Song Guanyang;Zhang Hui;Feng Hua(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院运动损伤科,北京100035

出　　处：《中国运动医学杂志》2018年第12期983-988,共6页Chinese Journal of Sports Medicine

基　　金：北京市医院管理局-临床技术创新项目(XMLX201613)

摘　　要：目的:探究以胫骨结节近端移位术为核心的"四合一"联合术式治疗成年人重度习惯性髌骨脱位的早期临床疗效。方法:2014年1月至2016年5月,43例(47例膝关节)习惯性髌骨脱位患者在我院接受治疗。其中11例患者(11例膝关节)被诊断为重度习惯性髌骨脱位并接受"四合一"联合手术,该联合手术包括胫骨结节近端移位术、外侧结构广泛松解术、胫骨结节内移术以及内侧髌骨股骨韧带重建术。术前及术后末次随访时临床评估主要包括体格检查、影像学测量以及主观评分。结果:全部11例患者均获得2年以上随访,随访时间平均为34.9个月(25至46个月)。术前所有患者均在屈膝角度小于30°时发生髌骨脱位,末次随访时,所有患者均未再脱位。影像学测量方面,适合角由术前73.4°±17.0°改善至术后-7.1°±5.8°(P<0.01)。外侧髌股角由术前-65.6°±9.4°改善至术后6.1°±2.7°(P<0.01),术后与术前差异均有统计学意义。主观评分方面,Kujala评分由术前平均42.9分提高至术后平均95.2分,差异存在统计学意义。结论:采用以胫骨结节近端移位术为核心的"四合一"联合术式治疗成年人重度习惯性髌骨脱位可以使患者获得满意的短期临床疗效。Objective To describe a novel"four-in-one"procedure,including tibial tubercle proximalization,extensive lateral release,tibial tubercle medialization,and medial patellofemoral ligament(MPFL) reconstructionin treating severe habitual patellar dislocation(HPD) in adults and to report its early clinical outcomes.Methods Forty-three consecutive adult patients(47 knees) with HPD surgically treated in our department between January2014 and May 2016 were selected and retrospectively reviewed.Among them,11 patients(11 knees) with se-vere primary HPD received the"four-in-one"procedure that included tibial tubercle proximalization,extensivelateral release,tibial tubercle medialization,and MPFL reconstruction.Before the operation and during the lastfollow-up after the operation,physical examinations,including the patellar tracking throughout the whole rangeof motion(ROM),the radiological assessments including the standard anteroposterior view,the true lateral viewat 30°of knee flexion,the axial views of the patellofemoral joint at both 30°and maximum angle of knee flex-ion,and the computed tomography(CT) scans at full knee extension,as well as the subjective patellofemoralfunction evaluation were conducted.Results All the 11 included patients were followed up for an average of34.9 months(range:25 to 46 months).All patients had the patella dislocated laterally with the average knee flex-ion angle less than 30°pre-operatively,demonstrating severe quadriceps contracture.After the "four-in-one"procedures,no patients were reported the recurrence of patellar dislocation at the final follow-up visit.Radio-graphically,there was a significant improvement in the congruence angle from 73.4°±17.0°pre-operatively to-7.1°±5.8°post-operatively(P<0.01) and in the lateral patellofemoral angle from-65.6°±9.4°pre-opera-tively to 6.1°±2.7°post-operatively(P<0.01).The average pre-operative Kujala functional score increased sig-nificantly from 42.9 to 95.2 after the operation(P<0.05).Conclusion The novel"four-in-one"procedure,in-c

关 键 词：习惯性髌骨脱位 重度 胫骨结节近端移位术 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]