股骨前倾角对复发性髌骨脱位术后髌骨稳定性的影响  

The Effect of Femoral Anteversion on Postoperative Patellar Stability in Patients with Recurrent Patellar Dislocation

作　　者：张志军 张辉[1] 宋关阳[1] 郑峒 冯华[1] Zhang Zhijun;Zhang Hui;Song Guanyang;Zheng Tong;Feng Hua(Department of Sports Medicine,Beijing Jishuitan Hospital,Beifing 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989-993,共5页Chinese Journal of Sports Medicine

基　　金：国家高技术研究发展计划(863计划)(2015AA043204);北京市医院管理局临床医学发展专项经费资助(XMLX201613);北京市医院管理局"登峰"计划专项经费资助(DFL20180402);北京市科学技术委员会资助课题(Z181100001718106);北京市卫生系统高层次卫生技术人才培养项目资助

摘　　要：目的:探讨对于行内侧髌股韧带重建联合胫骨结节内移截骨的复发性髌骨脱位患者,股骨前倾角对于术后髌骨稳定性的影响。方法:从2014年1月至2016年12月连续诊断为复发性髌骨脱位的患者中选取符合纳入标准的患者44名,根据股骨前倾角大小将患者分为前倾角增大组和前倾角正常组,在术前及术后二次关节镜检查时采用髌骨切线位应力像评估术后髌骨稳定性,并比较其在上述两组间的差异。结果:共44例患者入选该研究,在所有纳入患者中,股骨前倾角平均值为23.3±11.2(4.4～53)度,其中27人股骨前倾角大于20度,为前倾角增大组(n=27),17人股骨前倾角小于20度,为前倾角正常组(n=17)。对髌骨切线位应力像进行测量,术前前倾角增大组的髌骨外移距离为23.0±8.8 mm,前倾角正常组的髌骨外移距离为21.2±9.5 mm,两组差异无统计学意义(P=0.54)。术后二次关节镜检查时,前倾角增大组患者的应力像下髌骨外移距离明显大于前倾角正常组(9.0 mm vs 3.8 mm),其差异具有统计学意义(P<0.01)。结论:对于行MPFL重建联合胫骨结节内移截骨的复发性髌骨脱位患者,增大的股骨前倾角对术后髌骨稳定性有负面影响,可能会增加术后髌骨的外向松弛度。Objective To investigate the effect of different femoral anteversion angles on the postoperative pa-tellar stability in patients with recurrent patellar dislocation treated with MPFL reconstruction combined with me-dialization tibial tubercle osteotomy.Methods Forty-four recurrent patellar dislocation patients treated betweenJanuary 2014 and December 2016,were included in this study.Patients were divided into an increased femoralanteversion angle group and a normal femoral anteversion group according to their condition.The stress radiogra-phy of patella in tangential projection was used to assess the patellar stability before the operation and during asecond arthroscopy.Results Of the 44 patients included,the mean femoral anteversion angle was 23.3°±11.2°(range: 4.4°-53°).Among them,27 patients were of increased femoral anteversion of more than 20°,while 17 of the normal group with the femoral anteversion angle less than 20°.There was no significant difference in thepreoperative patellar shift distance between these two groups(21.2 mm vs 23.0 mm,P=0.54).However,the pa-tellar shift distance of the increased femoral anteversion group was significantly bigger than the normal groupduring a second arthroscopy check after surgery(9.0 mm v.s.3.8 mm)(P<0.01).Conclusion Increased femoral an-teversion may have a negative effect on clinical outcomes by increasing the lateral patellar instability in patientswith recurrent patellar dislocation treated with MPFL reconstruction combined with medialization tibial tubercleosteotomy.

关 键 词：复发性髌骨脱位 股骨前倾角 髌骨稳定性 

分 类 号：R687[医药卫生—骨科学]