股骨远端去旋转截骨联合内侧髌股韧带重建术治疗复发性髌骨脱位的早期疗效  

Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation

作　　者：李远 刘俊才 雷蕾 周鹏 邓富元 李忠 LI Yuan;LIU Juncai;LEI Lei;ZHOU Peng;DENG Fuyuan;LI Zhong(Department of Orthopaedics,the Affiliated Hospital of Southwest Medical University&Sichuan Provincial Laboratory of Orthopaedic Engineering,Luzhou Sichuan,646000,P.R.China;Department of Rehabilitation Medicine,the Affiliated Hospital of Southwest Medical University,Luzhou Sichuan,646000,P.R.China)

机构地区：[1]西南医科大学附属医院骨科,四川省骨科置入器械研发应用技术工程实验室,四川泸州646000 [2]西南医科大学附属医院康复科,四川泸州646000

出　　处：《中国修复重建外科杂志》2021年第3期343-348,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：四川大学-泸州市人民政府战略合作项目(2019CDLZ-17)。

摘　　要：目的探讨股骨远端去旋转截骨(derotational distal femoral osteotomy,DDFO)联合内侧髌股韧带(medial patellofemoral ligament,MPFL)重建术治疗股骨前倾角(femoral anteversion angle,FAA)过大(≥30°)的复发性髌骨脱位的早期疗效。方法2017年6月—2019年8月,收治17例FAA≥30°的复发性髌骨脱位患者,均行DDFO联合MPFL重建术治疗。男5例,女12例,年龄14~22岁,平均17.7岁。髌骨脱位2~8次,平均3.6次。病程2~7年,平均4.6年。膝关节恐惧试验均为阳性。术前疼痛视觉模拟评分(VAS)以及Lysholm评分、Tegner评分、Kujala评分分别为(4.2±1.1)、(47.8±8.1)、(3.6±1.1)、(56.8±5.7)分,影像学测量FAA、股骨远端外侧机械角(mechanical lateral distal femoral angle,mLDFA)、外侧髌骨移位值(lateral patella displacement,LPD)、胫骨结节-股骨滑车间距(tibial tuberosity-trochlear groove distance,TT-TG)分别为(34.9±3.4)°、(85.8±3.0)°、(13.7±3.8)mm、(23.1±2.1)mm。结果患者切口均Ⅰ期愈合,无膝关节僵硬、感染及髌骨再次脱位等并发症发生。患者均获随访,随访时间13~25个月,平均17.7个月。影像学复查显示,1例截骨不愈合,经二次手术翻修加强固定后愈合;其余患者截骨均于术后3~4个月完全愈合。末次随访时,膝关节恐惧试验均为阴性;FAA、mLDFA、LPD以及TT-TG分别为(15.6±2.7)°、(83.0±2.1)°、(5.0±2.6)mm、(20.5±2.5)mm,VAS评分、Lysholm评分、Tegner评分以及Kujala评分分别为(2.4±1.4)、(93.4±7.8)、(6.8±1.5)、(89.0±8.0)分,上述指标与术前比较差异均有统计学意义(P<0.05)。结论DDFO联合MPFL重建术治疗FAA过大(≥30°)的复发性髌骨脱位可获得良好早期疗效,膝关节疼痛明显减轻、功能明显改善。Objective To investigate the short-term effectiveness of derotational distal femoral osteotomy(DDFO)combined with medial patellofemoral ligament(MPFL)reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle(FAA≥30°).Methods Between June 2017 and August 2019,17 patients with recurrent patellar dislocation with FAA≥30°were treated with DDFO and MPFL reconstruction.There were5 males and 12 females,aged 14-22 years,with an average of 17.7 years.The patella dislocated for 2 to 8 times(mean,3.6 times).The disease duration was 2-7 years(mean,4.6 years).The patellar apprehension tests were positive.Preoperative pain visual analogue scale(VAS)score,Lysholm score,Tegner score,and Kujala score were 4.2±1.1,47.8±8.1,3.6±1.1,and56.8±5.7,respectively.FAA,mechanical lateral distal femoral angle(mLDFA),lateral patella displacement(LPD),tibial tuberosity-trochlear groove distance(TT-TG)were(34.9±3.4)°,(85.8±3.0)°,(13.7±3.8)mm,and(23.1±2.1)mm,respectively.Results All incisions healed by first intention,and there was no complications such as knee stiffness,infection,and re-dislocation of the patella.All patients were followed up 13-25 months,with an average of 17.7 months.The imaging review showed that 1 case of osteotomy did not union,and achieved satisfactory results after the secondary revision and strengthening fixation;the osteotomies of other patients healed completely after 3 to 4 months of operation.The patellar apprehension tests were negative.At last follow-up,the FAA,mLDFA,LPD,and TT-TG were(15.6±2.7)°,(83.0±2.1)°,(5.0±2.6)mm,and(20.5±2.5)mm,respectively;the VAS score,Lysholm score,Tegner score,and Kujala score were 2.4±1.4,93.4±7.8,6.8±1.5,and 89.0±8.0,respectively.There were significant differences in the above indicators between pre-and post-operation(P<0.05).Conclusion DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA(≥30°)can achieve good short-term effectiveness,significantly reduce knee pain,an

关 键 词：复发性髌骨脱位 股骨远端去旋转截骨 内侧髌股韧带 韧带重建 

分 类 号：R687.4[医药卫生—骨科学]