关节镜下髌外侧支持带松解、髌骨双半隧道解剖重建内侧髌股韧带联合Fulkerson截骨治疗复发性髌骨脱位  

Arthroscopic lateral retinacular release, patellar bi-half tunnel anatomical medial patellofemoral ligament reconstruction combined with Fulkerson osteotomy for recurrent patellar dislocation

作　　者：郭振中[1] 王孟飞 王昕 姚毅[1] 牛志强[1] GUO Zhenzhong;WANG Mengfei;WANG Xin;YAO Yi;NIU Zhiqiang(Department of Orthopaedics, General Hospital of Jizhong Energy Fengfeng Group, Handan 056200, Hebei;Department of Orthopedics, Tumor Hospital of Cixian, Handan 056500, Hebei, China)

机构地区：[1]冀中能源峰峰集团总医院骨六科,河北邯郸056200 [2]磁县肿瘤医院骨科,河北邯郸056500

出　　处：《中华骨与关节外科杂志》2018年第4期316-320,共5页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:目前,复发性髌骨脱位多采用手术治疗。内侧髌股韧带(MPFL)重建能够达到较好的临床效果,但伴有髌股关节骨性异常时,则需联合胫骨结节截骨术。目的:探讨关节镜下髌外侧支持带松解、髌骨双半隧道解剖重建MFPL联合Fulkerson截骨治疗复发性髌骨脱位的疗效。方法:回顾分析2011年5月至2015年5月冀中能源峰峰集团总医院收治的21例复发性髌骨脱位患者。男9例,女12例,年龄15~38岁,(23.2±4.5)岁。患者均为髌骨外侧脱位,术前脱位4~16次,平均6次。所有患者行关节镜下髌外侧支持带松解、髌骨双半隧道解剖重建MFPL联合Fulkerson截骨术。手术前后对膝关节功能进行评估,包括髌股适合角、髌骨倾斜角、外侧髌股角、髌骨外移度、胫骨结节-滑车间距(TT-TG值)及髌骨Q角,并记录IKDC主观评分、Kujala评分、Lysholm评分、Tegner活动评分。随访时行髌骨外推恐惧试验,记录并发症、转归及髌骨再脱位发生率,检查髌骨稳定性。结果:所有患者均得到随访,随访时间20~48个月,平均(34.5±2.5)个月。术后6个月内,2例出现髌骨外侧疼痛,1例出现髌骨内侧牵拉紧绷感,经物理治疗及功能锻炼后症状逐渐消失或好转。术后3~6个月复查X线片及CT平扫见胫骨结节截骨块骨性愈合。所有患者均无异物排斥反应、感染等并发症发生,至随访结束均未发生髌骨再脱位。末次随访时,髌骨稳定性较术前明显增强,髌骨外推恐惧试验阳性率为0%,膝关节相关功能评分及测量值均与膝关节发育正常人相仿。结论:关节镜下髌外侧支持带松解、髌骨双半隧道解剖重建MFPL联合Fulkerson截骨治疗复发性髌骨脱位具有创伤小,固定牢靠,恢复快等优点,值得临床推广应用。Background： At present, surgical treatment is often used for recurrent patellar dislocation. Medial patellofemoral ligament （MFPL） reconstruction can achieve favourable results, but it is necessary to apply additionally tibial tubercle osteotomy in the dislocation in combination of patellofemoral joint abnormalities. Objective： To investigate therapeutic effect of arthroscopic lateral retinacular release, patellar bi-half tunnel anatomical MFPL reconstruction combined with Fulkerson osteotomy on the recurrent patellar dislocation. Methods： Totally 21 patients with recurrent lateral dislocation of the patella treated between May 2011 to May 2015 were enrolled in this retrospective study. There were 9 males and 12 females with an average age of （23.2±4.5） years （range, 15-38 years）. The dislocation occurred 6 times on average （4-16 times） before operation. All the patients underwent arthroscopic lateral retinacular release, patellar bi-half tunnel anatomical MFPL reconstruction and Fulkerson osteotomy. IKDC （International Knee Documentation Committee） subjective score, Kujala score, Lysholm score, Tegner scale, patellar Q angle, congruence angle, lateral patellar angle, patellar tilt angle, lateral patellar translation and tibial tubercle-trochlear groove distance （TT-TG value） were measured and recorded before operation and during follow-up for knee joint functional evaluation. Moreover, during follow-up, Apprehension Test was performed, patel- lar stability was detected manually, and the incidences of complications and re-dislocation were recorded. Results： The mean duration of follow-up was （34.5±2.5） months （range, 20-48 months） in the 21 patients. Patellar lateral pain occurred in 2 patients and patellar medial tension occurred in one patient within 6 months after operation, which gradually disappeared after exercise and physiotherapy. Bony union was found in the tubercle of tibia 3-6 months after operation. No rejection reaction, infection or patellar dislocation happ

关 键 词：复发性髌骨脱位 外侧支持带松解 内侧髌股韧带解剖重建 髌骨双半隧道 Fulkerson截骨 关节镜 

分 类 号：R687.4[医药卫生—骨科学]