成人复发性髌骨脱位术后膝关节"J"形征阳性对内侧髌股韧带松弛度的影响  

Relationship between post-operative residual patellar J sign and the laxity of reconstructed medial patellofemoral ligament in recurrent patellar instability adult patients

作　　者：薛喆 宋关阳[1] 张辉[1] 冯华[1] Xue Zhe;Song Guanyang;Zhang Hui;Feng Hua(Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing 100035, China)

机构地区：[1]北京积水潭医院运动损伤科,100035

出　　处：《中华骨科杂志》2019年第7期414-421,共8页Chinese Journal of Orthopaedics

基　　金：北京市医院管理局临床技术创新项目(XMLX201613).

摘　　要：目的探讨内侧髌股韧带重建术+胫骨结节截骨术后膝关节"J"形征阳性对重建的内侧髌股韧带移植物松弛度的影响。方法回顾性分析接受内侧髌股韧带重建术+胫骨结节截骨术治疗的成人复发性髌骨脱位且随访时间不小于2年的患者39例。末次随访时评估髌骨运动轨迹,根据有无膝关节"J"形征分为阳性组及阴性组。比较两组末次随访时的髌骨稳定性(麻醉下髌骨外推试验)、CT参数(胫骨结节-股骨滑车沟距离、髌骨平分指数、髌骨-股骨滑车沟距离、髌骨外侧倾斜角、股骨前倾角、胫骨外旋角、膝关节旋转角)、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)评分、髌股关节功能Kujala评分及Lysholm膝关节评分。结果随访时间(26.3±6.7)个月(范围24~31个月),随访期间未再次出现髌骨脱位。"J"形征阳性组10例,"J"形征阴性组29例。两组患者年龄、性别、受伤侧别、随访时间、术前膝关节功能评分的差异无统计学意义(P>0.05)。末次随访时"J"形征阳性组麻醉下髌骨外推指数(34.9%±6.9%)大于阴性组(24.6%±8.6%),差异有统计学意义(t=-3.413,P=0.002);阳性组髌骨平分指数(102.9%±12.4%)大于阴性组(76.0%±18.4%),差异有统计学意义(t=-4.268,P=0.000);阳性组髌骨-股骨滑车沟距离[(2.2±3.7)mm)]大于阴性组[(-7.6±5.8)mm],差异有统计学意义(t=-4.223,P=0.000);其他CT参数的组间差异无统计学意义(P>0.05)。阳性组IKDC评分由术前(53.3±2.4)分提高至(86.4±6.5)分(t=-10.163,P=0.000),Kujala评分由术前(73.2±9.7)分提高至(85.3±1.1)分(t=-1.274,P=0.023),Lysholm评分由术前(76.7±6.6)分提高至(91.5±7.9)分(t=-8.533,P=0.018);阴性组IKDC评分由术前(49.1±4.6)分提高至(87.3±8.6)分(t=-14.381,P=0.000),Kujala评分由术前(71.4±6.5)分提高至(84.3±4.7)分(t=-0.068,P=0.037),Lysholm评分由术前(79.5±7.0)分提高至(93.1±4.3)分(t=-6.902,P=0.013);末次随访时阳性组与阴性组膝关�Objective To discover the relationship between the post-operative positive residual patellar J sign and the laxity of reconstructed medial patellofemoral ligament (MPFL) after MPFL reconstruction combined with tibial tubercle osteotomy (TTO). Methods A total of 39 consecutive recurrent patellar dislocation (RPD) adult patients who were performed MPFL reconstruction and TTO with more than 2 follow-up time were analyzed retrospectively in the present study. The patellar tracking of all the patients was evaluated and was classified into positive patellar J sign group and negative J sign control group during knee active flexion and extension at final follow up. The computed tomography (CT) examination was performed in all patients at 0° extension of the knee. The patellar laxity index measured by patellar glide test (PGT) and the radiographic parameters (tibial tuberosity-trochlear groove distance, bisect offset index, patella trochlear-groove distance, patella lateral tilt angle, femoral anteversion angle, tibial external angle and knee rotational angle) calculated by CT scans slices as well as the pre-/post- operative knee functional scores including International Knee Documentation Committee (IKDC) score, Kujala score, and Lysholm score were compared between the positive group and negative group at final follow up. Results The average follow-up duration was 26.3±6.7 months (range 24-31) and all the patients did not suffer from the RPD during the follow-up. Ten (26%, 10/39) patients performed positive J sign, and the remaining 29 (74%, 29/39) performed negatively. The two groups were compatible with no significant difference in age, gender, injury side, follow-up duration and preoperative knee function scores (P>0.05). At the final follow up, the patellar laxity index in the positive J sign group was 34.9%±6.9%, while that in the negative group was 24.6%±8.6%. There was significantly difference in the patellar laxity index between two groups (t=-3.413, P=0.002). The bisect offset index in the positive group was

关 键 词：髌股关节 创伤和损伤 关节镜检查 关节不稳定性 

分 类 号：R687.4[医药卫生—骨科学]