不伴有骨性畸形的复发性髌骨脱位的单纯内侧髌骨股骨韧带重建术治疗  

Isolated medial patellofemoral ligament reconstruction in the treatment of recurrent patellar dislocation without bony deformities

作　　者：田鹏 闫伦春 

机构地区：[1]内蒙古自治区巴彦淖尔市临河区人民医院骨科,内蒙古巴彦淖尔015000

出　　处：《中国医药科学》2017年第17期199-204,共6页China Medicine And Pharmacy

摘　　要：目的评估单纯MPFL重建治疗不合并骨性畸形的复发性髌骨脱位患者的临床疗效。方法本研究选取2012年5月~2014年5月经复发性髌骨脱位经手术治疗的患者共106例。根据入选和排除标准,共入选研究34位患者。术前测量患者的胫骨结节-滑车沟距离(TT-TG),滑车发育分型以及下肢力线情况,术后第1,3,12和24月进行随访,评估指标包括:改良版的Cincinnati评分和Kujala评分,解剖学测量参数以及肌力测量。结果本研究研究的平均随访时间为(3.1±1.6)年(2.0~3.9年)。在最终随访中,未出现髌股关节不稳定的报告,也未发现影像学上髌骨脱位或半脱位的证据。主观评分方面,Cincinnati改良评分平均从术前的(52±22)分升高到(89±29)分(P=0.001)。Kujala改良评分平均从术前的(45±12)分升高到(83±21)分(P=0.003)。Tenger评分从术前的(2.1±0.6)分增加为(4.6±1.1)分(P=0.021)。客观表现方面,术前平均Insall-Salvati指数为(1.1±0.2),术后为(1.1±0.7),P=0.07,未出现高位或低位髌骨。患侧和对侧肢体的等张肌力有显著的统计学差异(P=0.007)。结论对于术前没有任何骨性解剖学异常因素的复发性髌骨脱位的患者,单纯重建内侧髌骨股骨韧带,在主观和客观方面都能得到满意的临床效果。Objective To evaluate the clinical effect of isolated medial patellofemoral ligament reconstruction in the treatment of recurrent patellar dislocation without bony deformities. Methods 160 cases of consecutive patients underwent surgical intervention for recurrent patellar dislocation from May 2012 to May 2014 were selected. 34 eligible patients were included for evaluation. The tibial tuberosity - trochlear groove （TT-TG） distance, type of trochlear dysplasia and lower limb alignment were measured. Follow-up were performed at 1, 3, 12 and 24 months postoperatively. Patients were assessed with modified Cincinnati, and Kujala scores. Anatomic parameters and muscle power were also recorded. Results Patients were followed for a mean of （3.1 ± 1.6） （2.0-3.9） years. At the final follow-up, no episode of patellar dislocation were reported. No radiological evidence of patellar dislocation was found. Modified Cincinnati score significantly increased from （52± 22） to （89 ± 29） （P=0.001）. Kujala score significantly increased from （45±12） to （83± 21） （P=0.003）. Tegner score improved from （2.1 ± 0.6） to （4.6 ± 1.1） （P=0.021）. Preoperatively, Insall-Salvati index was （1.1± 0.2）, which was not significantly different from （1.1 ±0.7） （P=0.07） at the final follow-up. There was a significant difference in isometric muscle power between the operated and contralateral healthy knee （P=0.007）. Conclusion For patients of recurrent patellar dislocation without any bony deformities, isolated MPFL reconstruction is sufficient to restore the stability with satisfying clinical outcome.

关 键 词：髌骨 复发性脱位 内侧髌骨股骨韧带 重建 

分 类 号：R686.5[医药卫生—骨科学]