内侧髌股韧带联合髌胫韧带重建治疗复发性髌骨脱位  

Treatment of Recurrent Patellar Dislocation Viamedial Patellafemoral Ligament and Medial Patellotibial Ligament Reconstruction

作　　者：程松苗 蒋旭 陈鹏旭 范志航 李强[1] 胡勇[1] Cheng Songmiao;Jiang Xu;Cheng Pengxu(Department of Knee Sports Injuries,Orthopedic Hospital of Sichuan,Chengdu 610041,China)

机构地区：[1]四川省骨科医院膝关节运动损伤科,四川成都610041

出　　处：《实用骨科杂志》2020年第5期412-415,426,共5页Journal of Practical Orthopaedics

摘　　要：目的评价用半腱肌腱重建内侧髌股韧带和用髌韧带内1/3重建髌胫韧带治疗复发性髌骨脱位的临床疗效和影像学结果。方法回顾性分析我科2013年6月至2018年6月收治的25例复发性髌骨脱位患者,其中男性6例,女性19例;年龄15~38岁,平均(22.36±5.20)岁。全部患者均在麻醉下取半腱肌肌腱重建髌股韧带,取髌韧带内1/3带胫骨结节骨块重建髌胫韧带。术后复查CT和X线,测量髌骨-股骨适配角、髌骨倾斜角,髌骨外移度、Caton指数、胫骨结节-股骨滑车沟(tibial tubercle-trochlear groove,TT-TG)距离值作为影像学评价;以膝关节功能Lyshlom评分、Kujala评分、J形征和恐惧试验作为临床疗效评价。结果25例患者均获得随访,随访时间12~48个月,平均(18.16±6.85)个月。患者术后均未再次脱位。Kujala评分:术前(54.60±11.08)分,术后(75.40±7.49)分;Lysholm评分:术前(43.48±6.78)分,术后(93.20±3.52)分;手术前后比较差异有统计学意义(P<0.05)。影像学检查结果提示,髌骨-股骨适配角:术前(13.74±5.09)°,术后(4.14±2.52)°;髌骨倾斜角:术前(16.89±4.09)°,术后(3.40±1.37)°;髌骨外移度:术前(33.14±3.99)mm,术后(7.40±2.69)mm;手术前后比较差异有统计学意义(P<0.05)。TT-TG值、Caton指数手术前后比较差异无统计学意义(P>0.05)。查体J形征阴性,恐惧试验阴性。结论本研究采用半腱肌肌腱重建髌股韧带联合髌韧带内1/3重建髌胫韧带治疗复发性髌骨脱位,在技术上是安全,可在短期随访时间内取得良好的临床效果。Objective To evaluate the clinical efficacy and imaging results of reconstruction of the medial patellofemoral ligament with semitendinotendon and the medial patellotibial ligament with medial 1/3 of the patellar ligament in the treatment of recurrent patellar dislocation.Methods This study retrospectively analyzed 25 patients diagnosed with recurrent patellar dislocation who were admitted from Jun.2013 to Jun.2018,including 6 males and 19 females.The age ranged from 15 to 38 and the average age was(22.36±5.20).Semitendinosus tendon was taken to reconstruct patellofemoral ligament under anesthesia,medial 1/3 of the patellar ligament connected with bone block from tibial tubercle was taken to reconstruct patellotibial ligament.CT-scan and X-ray examination were reexamined post-operation as imaging evaluation,and the patellar femoral adaptation Angle,patella inclination angle,patella migration degree,Caton index,TT-TG value(Tibia Tuberosiy-Trochlear Groove)were measured.Lyshlom score,Kujala score,J-sign and apprehensive test were used to evaluate Knee function.Results All of the 25 participants were followed up for 12 to 48 months,with an average of(18.16±6.85)months.No recurrent dislocation was reported.The preoperative and postoperative Kujala score was(54.60±11.08)and(75.40±7.49)separately,the Lysholm score was(43.48±6.78)and(93.20±3.52)respectively,and the difference was statistically significant(P<0.05).According to the imaging evaluation,the patellar femoral adaptation Angle was(13.74±5.09)°and(4.14±2.52)°in pre-operation and pos-topration,the patellar tilt Angle was(16.89±4.09)°and(3.40±1.37)°respectively,the offshoring of patellar degrees was(33.14±3.99)and(7.40±2.69)respectively,and the differences were statistically significant(P<0.05).No statistically significant difference was found when TT-TG values and Caton index were compared before and after operation(P>0.05).J-signs were negative and Apprehensive tests were negative for all the patients.Conclusion The reconstruction of patellofemor

关 键 词：复发性髌骨脱位 髌胫韧带重建 髌股韧带重建 

分 类 号：R687.3[医药卫生—骨科学]