成人习惯性髌骨脱位的分型与治疗  

Clinical classification and surgical treatment of habitual dislocation of the patella in adult

作　　者：张辉[1] 冯华[1] 刘心[1] 洪雷[1] 王雪松[1] 

机构地区：[1]北京积水潭医院运动医学科,100035

出　　处：《中华骨科杂志》2018年第5期272-279,共8页Chinese Journal of Orthopaedics

基　　金：北京市卫生系统高层次卫生技术人才培养计划（2014-3-030）

摘　　要：目的 探讨成人习惯性髌骨脱位的临床分型及使用外侧松解、股外侧肌腱切断延长、胫骨结节近端移位、内侧髌股韧带（medial patellofemoral ligament,MPFL）重建治疗成人习惯性髌骨脱位的临床疗效。方法 回顾性分析2011年1月至2016年1月,治疗习惯性髌骨脱位并随访2年以上的36例患者资料,男12例,女24例;年龄15~44岁,平均24.0岁;翻修手术10例,初次手术26例。依据髌骨发生脱位的屈膝角度和手法内推复位髌骨的难易程度,将习惯性髌骨脱位分为轻度、中度和重度,轻度患者的脱位角度 〉90°,采用外侧松解联合MPFL重建治疗;中度患者的脱位角度约60°~90°,采用外侧松解、股外侧肌腱切断延长和MPFL重建治疗;重度患者的脱位角度〈 60°,采用外侧松解、股外侧肌腱切断延长、胫骨结节近端移位和MPFL重建治疗。结果 36例患者均获得随访,随访时间23~78个月,平均38.6个月;无一例发生再脱位。轻度组1例患者的髌骨适合角由术前72°改善为术后5°,Caton-Deschamps 指数为0.82,股骨滑车-胫骨结节间距（tibial tubercle-trochlear groove, TT-TG）为28 mm,股骨滑车沟角150°;Lysholm评分由术前59分改善为术后100分;Kujala评分由术前55分改善为术后83分。中度组6例患者的髌骨适合角由术前平均82.2°±11.7°改善为术后6.9°±26.4°,术前与术后比较差异有统计学意义。Caton-Deschamps指数、TT-TG和股骨滑车沟角术前与术后比较差异均无统计学意义;术后Lysholm评分的中位数为93分,术前61分,术前与术后比较差异有统计学意义;术后Kujala平均分,术前（55.0±4.1）分,术前与术后比较差异有统计学意义。重度组29例髌骨适合角由术前平均75.0°±27.3°改善为术后0.0°±21.0°;Caton-Deschamps 指数由术前平均0.76±0.24改善为术后平均1.06±0.24;TT-TG由术前平均（22.9±5.1）mm减小为术后（6.0±4.9）mm;以上各指标术前与术后比较差异有统计学意义;�Objective To explore the efficacy of the 3 types classification and the surgical technique included intensive lateral release, vastus lateralis oblique （VLO） tendon lengthening, tibial tubercle proximalization combined with MPFL reconstruction for habitual patellar dislocations in adults. Methods Date of 36 patients with habitual dislocation of patella who were operated between January 2011 and January 2016 were retrospectively analyzed. There were 12 males and 24 females, with an average age of 24 years old （range, 15-44 years）. All the cases were followed-up for more than 2 years, and 26 of which was primary surgery, while the other 10 was revision surgery. According to the flexion angle when the patella dislocation occurred and difficulty to reduce the patella, the patients were divided into 3 types. The mild type means patellar dislocation angle was more than 90°, and the treatment was lateral release （LR） combined with MPFL reconstruction. The moderate type means the patellar dislocation angle was about 60° to 90°, and the treatment was LR combined with VLO lengthening and MPFL reconstruction. The severe type means the patellar dislocation angle was less than 60°, and the treatment was LR＋VLO combined with proximalization of tibial tubercle. Based on this surgical algorithm, all the patients reveived the surgical treatment. Results All 36 patients had been sucessfully followed up. The mean follow-up period was 38.6 （range, 23-78） months. All the patients gained stable patella with no recurrence of dislocation. There was 1 patient in the mild group, 6 patients in the moderate group and 29 patients in the severe group. The patient in the mild group showed that the congruence angle of was improved from 72° preoperatively to 5° postoperatively, with 0.82 of Caton-Deschamps index, and 28mm of tibial tubercle-trochlear Groove, and the sulcus angle was 150°. The 6 patients in the moderate group showed that the congruence angle of was improved from mean 82.2°±11.7° preoperatively to 6.9°

关 键 词：髌骨脱位 成年人 治疗结果 

分 类 号：R687.4[医药卫生—骨科学]