经髌骨打结固定移植肌腱髌骨端解剖重建内侧髌股韧带治疗复发性髌骨脱位的临床研究  

A clinical study of transpatellar knotting fixation of patellar end of transplanted tendon in the surgery of anatomical reconstruction of medial patellofemoral ligament for treatment of recurrent patellar dislocation

作　　者：米豫飞 苏春霞 邹春雨 杨澜波 乔清奎 王战朝 MI Yufei;SU Chunxia;ZOU Chunyu;YANG Lanbo;QIAO Qingkui;WANG Zhanchao(Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China)

机构地区：[1]河南省洛阳正骨医院/河南省骨科医院,河南洛阳471002

出　　处：《中医正骨》2020年第6期12-17,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨经髌骨打结固定移植肌腱髌骨端解剖重建内侧髌股韧带治疗复发性髌骨脱位的临床疗效和安全性。方法:回顾性分析采用解剖重建内侧髌股韧带治疗的60例复发性髌骨脱位患者的病例资料,其中移植肌腱髌骨端采用经髌骨打结固定者30例(打结固定组)、采用带线锚钉固定者30例(锚钉固定组)。比较2组患者的Lysholm评分、Kujala评分、屈膝30°时的髌骨倾斜角和髌骨适合角、髌骨脱位复发及并发症发生情况。结果:所有患者均获得随访,随访时间为6~18个月,中位数10个月。18例行胫骨结节内移的患者,胫骨结节均骨性愈合。①Lysholm评分。术前与术后6个月,2组患者Lysholm评分比较,差异均无统计学意义[(60.5±6.6)分,(58.4±7.6)分,t=0.243,P=0.404;(88.6±3.2)分,(87.8±4.6)分,t=0.354,P=0.362];术后6个月,2组患者Lysholm评分均较术前提高(t=-2.864,P=0.003;t=-3.057,P=0.002)。②Kujala评分。术前与术后6个月,2组患者Kujala评分比较,差异均无统计学意义[(53.5±5.2)分,(54.2±3.5)分,t=0.294,P=0.385;(80.9±7.6)分,(81.7±5.6)分,t=-0.287,P=0.388];术后6个月,2组患者Kujala评分均较术前提高(t=-3.364,P=0.001;t=-3.223,P=0.001)。③屈膝30°时的髌骨倾斜角。术前与术后6个月,2组患者屈膝30°时的髌骨倾斜角比较,差异均无统计学意义(12.5°±3.2°,12.3°±2.5°,t=0.326,P=0.373;4.5°±2.5°,4.1°±2.7°,t=0.426,P=0.336);术后6个月,2组患者屈膝30°时的髌骨倾斜角均较术前减小(t=1.986,P=0.028;t=2.183,P=0.018)。④屈膝30°时的髌骨适合角。术前与术后6个月,2组患者屈膝30°时的髌骨适合角比较,差异均无统计学意义(9.5°±1.2°,10.9°±2.3°,t=0.185,P=0.427;1.5°±1.7°,1.9°±1.5°,t=-0.396,P=0.347);术后6个月,2组患者屈膝30°时的髌骨适合角均较术前减小(t=2.426,P=0.010;t=2.537,P=0.008)。打结固定组3例、锚钉固定组2例发生切口脂肪液化,经换药治疗后愈合;打结固定组和锚钉固定组各�Objective:To explore the clinical curative effects and the safety of transpatellar knotting fixation of patellar end of transplanted tendon in the surgery of anatomical reconstruction of medial patellofemoral ligament(MPFL)for treatment of recurrent patellar dislocation.Methods:The medical records of 60 patients who received anatomical reconstruction of MPFL for treatment of recurrent patellar dislocation were analyzed retrospectively.The patellar end of transplanted tendon was fixed by transpatellar knotting(knotting fixation group)and suture anchors(anchor fixation group)respectively,30 cases in each group.The Lysholm scores,Kujala scores,patellar tilt angle(PTA)and patellar congruence angle(PCA)at 30 degrees of knee flexion,recurrence of patellar dislocation and complications were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 6-18 months with a median of 10 months.Anteromedial tibial tubercle transfer was performed on 18 patients,and all patients got bone union in tibial tubercles.There was no statistical difference in Lysholm scores between the 2 groups before the surgery and at 6 months after the surgery(60.5+/-6.6 vs 58.4+/-7.6 points,t=0.243,P=0.404;88.6+/-3.2 vs 87.8+/-4.6 points,t=0.354,P=0.362).The Lysholm scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=-2.864,P=0.003;t=-3.057,P=0.002).There was no statistical difference in Kujala scores between the 2 groups before the surgery and at 6 months after the surgery(53.5+/-5.2 vs 54.2+/-3.5 points,t=0.294,P=0.385;80.9+/-7.6 vs 81.7+/-5.6 points,t=-0.287,P=0.388).The Kujala scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=-3.364,P=0.001;t=-3.223,P=0.001).There was no statistical difference in PTA at 30 degrees of knee flexion between the 2 groups before the surgery and at 6 months after the surgery(12.5+/-3.2 vs 12.3+/-2.5 degrees,t=0.326,P=0.373;4.5+/-2.5 vs 4.1+/-2.7 degrees,t=0.426,P=0.336).The PTA at 30 degrees of knee flexion decrease

关 键 词：髌骨脱位 复发 内侧髌股韧带 临床试验 

分 类 号：R687.3[医药卫生—骨科学]