关节镜下内侧髌股韧带重建联合外侧支持带松解治疗复发性髌骨脱位的临床研究  

A clinical study on the treatment of recurrent patella dislocation with arthroscopic reconstruction of medial patellofemoral ligament combined with lateral retinacular release

作　　者：熊冰朗 林天烨 杨鹏[1] 徐景利[1] 邹启昭 赖启忠 张庆文[2] XIONG Bing-lang;LIN Tian-ye;YANG Peng;XU Jing-li;ZOU Qi-zhao;LAI Qi-zhong;ZHANG Qing-wen(The First Clinical Medical College,Guangzhou University of Chinese Medicine,Guangzhou,Guangdong,510405,China)

机构地区：[1]广州中医药大学第一临床医学院,广东510405 [2]广州中医药大学第一附属医院关节骨科,广东510405

出　　处：《中国骨与关节杂志》2020年第10期752-757,共6页Chinese Journal of Bone and Joint

基　　金：广东省科技计划项目(2013A032500009);广东省科技计划项目(2011B060300029);广州市科技计划项(201510010228);广东省自然科学基金(2015A030313353)。

摘　　要：目的探讨关节镜下内侧髌股韧带重建联合外侧支持带松解治疗复发性髌骨脱位的手术方法和临床疗效。方法回顾性分析我院 2011 年 1 月至 2017 年 7 月收治的 26 例复发性髌骨脱位患者,其中男8 例,女 18 例;年龄 15~42 岁,平均 (30.3±12.4) 岁。所有患者都是初次手术,且都行关节镜下行内侧髌股韧带重建、外侧支持带松解术,比较术前术后膝关节 Lysholm 评分及 kujala 评分的差异,影像学评估采用外侧髌骨角、髌骨倾斜角、髌骨外移度。结果 26 例均获得随访,随访时间 24~86 个月,平均 48 个月,Lysholm 膝关节功能评分从术前的 (49.5±5.5) 分上升至 (93.2±2.8) 分;kujala 评分术前平均 (50.2±4.2) 分,术后改善至 (92.0±3.1) 分,差异均有统计学意义 (P<0.001)。外侧髌骨角由术前 (12.5±4.5) °下降至 (9.5±3.3) °,髌骨倾斜角由术前平均 (14.9±9.0) °下降至 (9.1±5.6) °,髌骨外移都由术前平均 (1.8±0.8) mm 下降至 (0.8±0.3) mm,差异均有统计学意义 (P<0.001)。本组术中无一例损伤血管及神经,术后无一例发生髌骨再脱位。结论关节镜下内侧髌股韧带重建联合外侧支持带松解治疗复发性髌骨脱位的疗效确切,可有效地防止髌骨再次脱位,具有手术创伤小、术后康复快等优点。Objective To explore the surgical method and clinical effects of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with lateral retinacular release in the treatment of recurrent patellar dislocation.Methods A retrospective analysis was conducted on 26 patients with recurrent patellar dislocation from January 2011 to July 2017,including 8 males and 18 females with an average age of (30.3±12.4) years (range:15-42 years).All patients underwent primary arthroscopic MPFL reconstruction combined with lateral retinacular release.Lysholm score and kujala score were compared before and after operation.Lateral patellofemoral angle,patellar tilt angle,and patellar gliding were evaluated by postoperative imaging examination.Results All 26 patients were followed up for 24-86 months with an average of 48 months.Lysholm knee function score increased from (49.5±5.5) before surgery to (93.2±2.8) after surgery (P < 0.001);kujala score improved from (50.2±4.2) before surgery to (92.0±3.1) after surgery (P < 0.001).Lateral patellofemoral angle decreased from (12.5±4.5) °before surgery to (9.5±3.3) ° after surgery (P < 0.001);patellar tilt angle decreased from (14.9±9.0) ° before surgery to (9.1±5.6) ° after surgery (P < 0.001);patellar gliding decreased from (1.8±0.8) mm before surgery to (0.8±0.3) mm after surgery (P < 0.001).No intraoperative blood vessel injury,nerve injured,or postoperative patella redislocation was observed.Conclusions Arthroscopic MPFL reconstruction combined with lateral retinacular release,as a less invasive surgery,can effectively prevent patella redislocation with faster postoperative recovery in the treatment of recurrent patellar dislocation.

关 键 词：髌骨脱位 关节镜 外科手术 髌股韧带 外侧支持带 

分 类 号：R687.4[医药卫生—骨科学]