股骨远端旋转截骨术与三联术式治疗伴有严重髌骨轨迹不良的复发性髌骨脱位的临床疗效比较  

Rotational Distal Femoral Osteotomy versus MPFL Reconstruction Combined with Tibial Tubercle Osteotomy Treating Recurrent Patellar Dislocation with Severe Patellar Mal-tracking:A Retrospective Comparative Study

作　　者：张志军 宋关阳[1] 李岳[1] 倪乾坤 曹晏维 冯峥 冯华[1] 张辉[1] Zhang Zhijun;Song Guanyang;Li Yue;Ni Qiankun;Cao Yanwei;Feng Zheng;Feng Hua;Zhang Hui(Department of Sports Medicine,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院运动损伤科,北京100035

出　　处：《中国运动医学杂志》2020年第10期755-759,共5页Chinese Journal of Sports Medicine

基　　金：北京市医院管理局“登峰”计划专项经费资助(DFL20180402);2020年首都卫生发展科研专项(首发2020-1-2071);2020年首都卫生发展科研专项(首发2020-2-2075)。

摘　　要：目的:对于伴有严重髌骨轨迹不良的复发性髌骨脱位患者,比较股骨远端旋转截骨与三联术式在临床疗效上的差异。方法:从2010年1月至2017年12月连续就诊的复发性髌骨脱位患者中筛选出术前存在严重髌骨轨迹不良的复发性髌骨脱位患者共50例,其中22例行股骨远端旋转截骨+内侧髌股韧带重建术(旋转截骨组),其余28例行传统三联术式(髌骨外侧支持带松解、内侧髌股韧带重建和胫骨结节移位)(对照组)。术前测量髌骨高度、滑车发育Dejour分型、胫骨结节-股骨滑车距离、股骨前倾角、胫骨外旋角等影像学参数。最终随访时评估临床功能评分(Kujala,Lysholm和Tegner评分)、髌骨松弛指数以及髌骨再脱位率,并比较上述指标在旋转截骨组和对照组间的差异。结果:本研究共纳入50例患者,平均随访时间为4.9年,亚组分析结果显示,旋转截骨组的Kujala评分(82.1 vs 76.2,P=0.016)和Tegner评分(5.2 vs 4.1,P=0.001)均显著高于对照组。髌骨应力像结果显示旋转截骨组的髌骨松弛指数显著低于对照组(29%vs 43%,P=0.011)。在随访期间,旋转截骨组患者无髌骨再脱位发生,但对照组有7名患者出现髌骨再脱位,其再脱位率显著高于旋转截骨组(25%vs 0,P=0.014)。结论:对于术前存在严重髌骨轨迹不良的复发性髌骨脱位患者,股骨远端旋转截骨的临床疗效显著优于三联术式,术后患者具有更高的临床功能评分,更好的术后髌骨稳定性及更低的髌骨再脱位率。Objective To compare the clinical outcomes of rotational distal femoral osteotomy versus medial patellofemoral ligament reconstruction(MPFL-R)combined with tibial tubercle osteotomy treating recurrent patellar dislocation with severe patellar mal-tracking.Methods Totally 50 recurrent patellar dislocation patients with severe patellar mal-tracking and treated between January 2010 and December 2017 were selected,and randomly divided into an experimental group of 22 and a control group of 28.The experimental group was treated with rotational distal femoral osteotomy combined with MPFLR,while the control group underwent traditional trigeminy surgery(including the lateral retinacular release,MPFL-R and tibial tubercle dislocation).Before the surgery,the patella height,trochlea development Dejour somatotype,tubercle of tibia-femur trolley distance,femur ante version angle and tibia rotational angle were measured on the CT imaging.The pre-and post-operative functional scores(Kujala,Lysholm,and Tegner scores),patellar laxity index redislocation rate were assessed and compared between the two groups.Results Fifty patients with a mean follow-up of 4.9 years were included in the present study.The experimental group had significantly higher Kujala score(82.1 vs 76.2,P=0.016)and Tegner score(5.2 vs 4.1,P=0.001)but lower patellar laxity index(29%vs 43%,P=0.011)than the control group.During the follow-up,no dislocation was found in the experimental group,while 7 patients were observed recurrent patella dislocation in the control group,showing a significantly higher redislocation rate(25%vs 0,P=0.014).Conclusion For recurrent patellar dislocation patients with severe patellar mal-tracking,rotational distal femoral osteotomy has better clinical outcomes than MPFL-R combined with tibial tubercle osteotomy.

关 键 词：复发性髌骨脱位 髌骨轨迹不良 旋转截骨 

分 类 号：R687.3[医药卫生—骨科学]