大收肌腱移位双束重建内侧髌股韧带联合远端重排治疗儿童复发性髌骨脱位  

A short-term follow-up study after double-bundle reconstruction of medial patellofemoral ligament with adductor magnus tendon autograft for recurrent dislocation of patella in children

作　　者：冯超[1] 郭源[1] Feng Chao;Guo Yuan(Department of Pediatric Orthopedics,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院小儿骨科,100035

出　　处：《中华小儿外科杂志》2020年第5期450-455,共6页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨大收肌腱移位双束重建内侧髌股韧带(medial patellofemoral ligament,MPFL)联合远端重排手术治疗儿童复发性髌骨脱位(recurrent dislocation of patella,RDP)的手术技术和临床效果。方法2016年8月至2018年8月北京积水潭医院小儿骨科收治了15例(17膝)的RDP患儿,术前进行Lysholm膝关节功能评分、临床体格检查,完善膝关节X线片、髋膝踝CT检查,了解下肢力线、扭转角度、髌股关节对合关系、髌骨高度等情况。手术步骤包括:①外侧支持带松解;②胫骨结节-股骨滑车间距(tibial tuberosity-trochlear groove distance,TT-TG)>20 mm者进行髌腱止点外侧半内移,Insall指数大于1.2者内移同时进行髌腱止点下移;③大收肌腱转位双束解剖重建MPFL。末次随访时膝关节X线片评价髌股关节对合关系、髌骨高度和运动轨迹恢复情况。结果所有患儿均获得随访,随访时间12~34个月(平23个月),均未出现髌骨再次脱位、感染及重建韧带再断裂的情况,Lysholm评分由术前平均76.7±8.6改善为术后94.2±5.6(P=0.000),髌骨倾斜角从28.6°±3.4°减小到7.6°±5.6°(P<0.05)。结论大收肌腱移位双束重建内侧髌股韧带联合远端重排治疗儿童复发性髌骨脱位初期效果满意,远期效果有待进一步观察。Objective To explore the techniques and clinical outcomes of combining distal realignment and double-bundle reconstruction of medial patellofemoral ligament(MPFL)with adductor magnus tendon autograft for recurrent dislocation of patella(RDP)in children and adolescents.Methods Fifteen cases(17 knees)of RDP were treated by this technique from August 2016 to August 2018.The surgical procedure involved a lateral release with a technique of distal re-alignment similar to goldthwaite in skeletally immature children except that this technique focused upon patella alta.As an enhancement procedure,double-bundle reconstruction of MPFL with adductor magnus tendon autograft was performed.Subjective symptoms,functional scores and physical examinations were recorded preoperatively and at the latest follow-up.The lower limb alignment and rotation,patellofemoral congruence,patella track and height were recorded with radiographic and computed tomography(CT)scans preoperatively.At the latest follow-up,lower limb alignment,patellofemoral congruence,patella track and height were re-evaluated with radiography.Results During an average follow-up period of 23(12-34)months,there was no occurrence of infection or graft rupture.Lysholm scores improved from(76.7±8.6)to(94.2±5.6)(P=0.000).Patellar tilt angle declined from(28.68°±3.38°)to(7.65°±5.66°)(P<0.05).Radiography indicated excellent patella reduction without a recurrence of dislocation or subluxaion.Conclusions RDP may be effectively managed by combining distal realignment and double-bundle reconstruction of MPFL with adductor magnus tendon autograft.

关 键 词：髌骨脱位 髌股韧带 儿童 

分 类 号：R726.8[医药卫生—儿科]