关节镜辅助定位股骨隧道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 femoral tunnel positioning assisted by arthroscopy in medial patellofemoral ligament reconstruction for treatment of recurrent patellar dislocation

作　　者：陈荦 顾圣华 章培峰 周建烽 CHEN Luo;GU Shenghua;ZHANG Peifeng;ZHOU Jianfeng(The Second People’sHospital of Zhujicity,Zhuji311811,Zhejiang,China)

机构地区：[1]诸暨市第二人民医院,浙江诸暨311811

出　　处：《中医正骨》2021年第7期11-16,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:探讨关节镜辅助定位股骨隧道重建内侧髌股韧带(medial patellofemoral ligament, MPFL)治疗复发性髌骨脱位的临床疗效和安全性。方法:对80例复发性髌骨脱位患者的病例资料进行回顾性分析,根据MPFL重建术中股骨隧道定位方式的不同分为关节镜定位组(采用关节镜辅助定位,42例)和触摸定位组(采用触摸股骨骨性标志定位,38例)。比较2组患者的手术时间、切口长度、术中出血量、股骨隧道等距隧道率、髌骨角、膝关节Lysholm评分、美国膝关节协会(the American Knee Society, AKS)评分及并发症发生率。结果:(1)一般结果。关节镜定位组手术时间、手术切口均短于触摸定位组,术中出血量少于触摸定位组[(65.4±6.4)min,(94.5±7.8)min,t=5.151,P=0.012;(4.1±0.3)cm,(8.2±1.8)cm,t=8.893,P=0.001;(149.7±24.5)mL,(207.2±30.3)mL,t=9.384,P=0.000]。2组患者随访时间12~18个月,中位数14个月。(2)股骨隧道等距隧道率和髌骨角。关节镜定位组等距点距离1.52~5.14 mm(中位数3.25 mm),股骨隧道均为等距隧道;触摸定位组等距点距离5.33~9.17 mm(中位数7.32 mm),股骨隧道为等距隧道者12例;关节镜定位组股骨隧道等距隧道率高于触摸定位组(P=0.000)。关节镜定位组髌骨角大于触摸定位组(12.2°±4.1°,10.3°±3.9°,t=9.482,P=0.000)。(3)膝关节评分。术前2组患者膝关节Lysholm评分、AKS评分组间比较,差异均无统计学意义[(38.07±1.48)分,(37.94±1.53)分,t=8.682,P=0.189;(43.22±4.77)分,(42.74±4.68)分,t=9.358,P=0.248];末次随访时,关节镜定位组膝关节Lysholm评分、AKS评分均高于触摸定位组[(95.47±0.49)分,(90.23±0.51)分,t=1.673,P=0.028;(96.25±0.59)分,(91.47±0.73)分,t=1.248,P=0.002]。(4)并发症发生率。术后关节镜定位组出现关节腔积血1例,触摸定位组出现切口感染2例、髌骨再脱位1例;2组患者并发症发生率比较,差异无统计学意义(χ~2=0.380,P=0.538)。结论:关节镜辅助定位股骨隧道重建MObjective:To explore the clinical curative effects and safety of femoral tunnel(FT)positioning assisted by arthroscopy in medial patellofemoral ligament(MPFL)reconstruction for treatment of recurrent patellar dislocation(RPD).Methods:The medical records of 80 patients who underwent MPFL reconstruction for treatment of RPD were analyzed retrospectively.The patients were divided into 2 groups according to FT positioning methods.The arthroscopic-assisted positioning method was used in 42 patients(AA positioning group),while palpation(palpating femoral bony landmarks)positioning method was used in 38 patients(palpation positioning group).The operative time,incision length,intraoperatve blood loss,FT isometric tunnel rate,patella angle,Lysholm knee score,the American Knee Society(AKS)score and complication incidence were compared between the 2 groups.Results:The operative time and incision length were shorter and the intraoperatve blood loss was less in AA positioning group compared to palpation positioning group(65.4±6.4 vs 94.5±7.8 minutes,t=5.151,P=0.012;4.1±0.3 vs 8.2±1.8 cm,t=8.893,P=0.001;149.7±24.5 vs 207.2±30.3 mL,t=9.384,P=0.000).All patients in the 2 groups were followed up for 12-18 months with a median of 14 months.The isometric point distance was 1.52-5.14 mm with a median of 3.25 mm,and all of the FTs were isometric tunnels in AA positioning group;while,in palpation positioning group,the isometric point distance was 5.33-9.17 mm with a median of 7.32 mm,and the isometric tunnels were found in 12 patients.The FT isometric tunnel rate was higher in AA positioning group compared to palpation positioning group(P=0.000),and the patella angles were greater in AA positioning group in contrast to palpation positioning group(12.2±4.1 vs 10.3±3.9 degrees,t=9.482,P=0.000).There was no statistical difference in Lysholm knee scores and AKS scores between the 2 groups before the surgery(38.07±1.48 vs 37.94±1.53 points,t=8.682,P=0.189;43.22±4.77 vs 42.74±4.68 points,t=9.358,P=0.248).The Lysholm knee scores

关 键 词：髌骨脱位 关节镜检查 修复外科手术 内侧髌股韧带 股骨隧道 

分 类 号：R687.4[医药卫生—骨科学]