关节镜下内侧髌股韧带重建联合胫骨结节移位术治疗复发性髌骨脱位五年随访  

Arthroscopic medial patellofemoral ligament reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation

作　　者：赵允[1] 黄竞敏[2] 李冬超 胡文晋 ZHAO Yun;HUANG Jingmin;LI Dongchao;HU Wenjin(Department of Orthopedics,Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital,Tianjin,300131,P.R.China;The Second Department of Sport Injury and Arthroscopy,Tianjin Hospital,Tianjin,300211,P.R.China)

机构地区：[1]天津市中医药研究院附属医院骨科,天津300131 [2]天津市天津医院运动损伤与关节镜二病区,天津300211

出　　处：《中国修复重建外科杂志》2019年第8期960-964,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨关节镜下内侧髌股韧带(medial patellofemoral ligament,MPFL)重建联合胫骨结节移位术治疗复发性髌骨脱位的疗效。方法 2012年2月-2013年12月,关节镜下行自体半腱肌双束等长重建MPFL联合胫骨结节移位术治疗24例(24膝)复发性髌骨脱位患者。男7例,女17例;年龄18~37岁,平均23.2岁。1例曾于外院手术后脱位复发,其余均为首次手术。病程6个月~20年,平均5.6年。恐惧试验及髌骨外推试验均为阳性。术前Lysholm评分为(49.79±11.67)分,Kujala评分为(49.63±6.28)分。X线片示13例髌骨及股骨滑车存在发育不良;8例存在高位髌骨(Caton-Deschamps指数>1.2);髌股适合角为(23.96±5.54)°。CT检测示胫骨结节-股骨滑车沟间距(tibial tuberosity-trochlear groove distance,TT-TG)值为(23.71±2.35)mm。结果术后切口均Ⅰ期愈合。22例获随访,随访时间59~81个月,平均66.8个月。随访期间均未出现再脱位;恐惧试验及髌骨外推试验均为阴性。术后1周X线片及CT复查,髌股适合角为(–1.96±4.65)°,TT-TG值为(13.75±1.89)mm,均较术前明显减小(P<0.05)。术后6个月、1年及末次随访时,Lysholm评分分别为(81.13±17.76)、(91.35±3.60)、(92.23±2.71)分,Kujala评分分别为(84.04±3.98)、(91.48±3.64)、(91.45±3.29)分;术后各时间点评分均较术前明显增加(P<0.05)。末次随访时按照Insall评价标准评定疗效,获优11例、良8例、可3例,优良率为86%。结论关节镜下自体半腱肌重建MPFL联合胫骨结节移位术治疗复发性髌骨脱位,可以有效改善髌股关节匹配关系,早中期疗效满意。Objective To investigate the effectiveness of arthroscopic medial patellofemoral ligament(MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation. Methods Between February 2012 and December 2013, 24 patients(24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years(range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years(mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea;8 patients had high tibia(Caton-Deschamps index>1.2);the congruence angle was(23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance(TTTG) value was(23.71±2.35) mm. Results All incisions healed by first intention. Twenty-two patients were followed up59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was(–1.96±4.65)°, and the TT-TG value was(13.75±1.89) mm, which were significantly lower than those before operation(P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76,91.35±3.60, and 92.23±2.71, respectively;and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores(P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%. Conclusion Arthroscopic MPFL recons

关 键 词：复发性髌骨脱位 内侧髌股韧带 韧带重建 胫骨结节移位术 关节镜 

分 类 号：R687.4[医药卫生—骨科学]