弧形骨槽联合骨筋膜覆盖技术双束解剖重建内侧髌股韧带  

Double-bundle anatomic reconstruction of MPFL reattached to patella with an arc-shaped bone groove covered by osseous fascia

作　　者：刘巍[1] 许宏涛[1] 高伟[1] 靳国荣[1] 赵志光[1] 高石军[1] 董江涛[1] 

机构地区：[1]河北医科大学第三医院关节二科,石家庄050051

出　　处：《中国矫形外科杂志》2017年第12期1134-1138,共5页Orthopedic Journal of China

摘　　要：[目的]探讨弧形骨槽联合髌内侧骨筋膜覆盖技术双束解剖重建内侧髌股韧带(medial patella femoral ligament,MPFL)治疗复发性髌骨脱位的中短期临床效果。[方法]回顾本院2012年2月~2015年10月诊断为复发性髌骨脱位的患者25例,其中男11例,女14例,年龄13~35岁,平均20.7岁,手术以收肌结节与股骨内上髁最高点连线的中点作为MPFL股骨止点并建立7 mm骨道,髌骨内缘1/3做髌骨侧止点,使用磨钻于该止点建立约2 cm的弧形骨槽以充分包埋移植物并用骨筋膜充分覆盖和固定移植物。将移植物两游离缘由髌骨侧从股内侧肌斜束与关节囊之间自股骨侧切口穿出并于骨道内口用可吸收界面螺钉固定。临床评价包括手术前后的Kujala、Lysholm和Tegner评分,影像学分析包括手术前后的髌股适合角(congruance angle,CA),髌骨倾斜角(patellar tilt angle,PTA),髌骨外移率(patellar lateral shift ratio,PLSR)。[结果]术后随访时间均在12个月以上,平均(18.84±4.95)个月,未见复发、感染等相关并发症。所有患者术后Kujala、Lysholm和Tegner临床评分较术前均有显著性改善(P<0.05)。所有患者影像学指标均恢复至正常范围,术前术后改变差异具有统计学意义(P<0.05)。[结论]弧形骨槽联合髌内侧骨筋膜覆盖技术双束解剖重建MPFL具有切口小、复发率低等优点,中短期临床疗效满意。[Objective] To explore the short and medium term outcome of douhle-bundle anatomic reeonstruetion of medial patella femoral ligament （MPFL） reattaehed to the patella hy an are-shaped bone groove covered with the osseous fas- cia lot treatment of recurrent patellar dislocation. [Methods] Twenty-five patients with recurrent patellar dislocation were surgically treated from February 2012 to October 2015, including 11 males and 14 females with an average age of 20.7 years （range, 13 to 35 years） . 1）uring the surgeD＇, the midpoint between the adductor tubercle and the medial femoral epieondyle was used as the femoral MPFL insertion where a hone tunnel of 7mm in diameter was drilled. While the proximal third of the pa- tellar medial margin was set as the patellar MPFL insertion where a longitudinal 2 em arc-shaped bone groove was made using an abrasion drill. The middle portion of tendon graft was inserted into the groove and fixed by No l Ethibond sutured with the covered osseous lhseia, subsequently, the both free ends of the graft were passed through the soft tunnel between the vastus medialis and capsule into the femoral tunnel. Finally the femoral insertion was secured with a absorbable interi}erenee screw un- der proper tension of the graft. The Kujala, Lysholm, and Tegner scores were used for clinical evaluation, additionally, con- gruence angle （CA）, patella tilt angle （PTA） and patellar lateral shift ratio （PI,SR） were nleasured for radiologieal assess- menl. [Results] All patients were tollowed up for more than 12 months, with an average of 18.84±4.95 months. No complica- tions such as re, lapse of patellar dislocation and infection occurred in any patient during follow-up period. The Kujala,Lysholm, and Tcgner seores achieved significant improve- ments compared with preoperative ones （P 〈 0.05） . More- over, the CA, PTA and PLSR were restored to normal lev- el, with statistically significant differenees compared with those preoperatively （P〈0.05）. [Conclusions] Dou-hie-b

关 键 词：弧形骨槽 骨筋膜 解剖重建 内侧髌股韧带 复发性髌骨脱位 

分 类 号：R687.4[医药卫生—骨科学]