股骨远端去旋转截骨术联合内侧髌股韧带重建治疗伴股骨前倾角增大的复发性髌骨脱位的中期临床疗效  

Medium-term Clinical Outcomes of Distal Derotational Femoral Osteotomy Combined with MPFL Reconstruction in Treating Recurrent Patellar Dislocation with Increased Femoral Anteversion

作　　者：王雪松[1] 张志军 张辉[1] Wang Xuesong;Zhang Zhijun;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医学科,北京100035

出　　处：《中国运动医学杂志》2022年第7期499-503,共5页Chinese Journal of Sports Medicine

基　　金：国家重点研发计划项目(2019YFF0301700);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:探究股骨远端去旋转截骨术联合内侧髌股韧带重建治疗伴股骨前倾角增大(>30°)的复发性髌骨脱位的中期临床疗效。方法:从2015年1月至2016年6月连续就诊的复发性髌骨脱位患者中筛选出股骨前倾角>30°并行股骨远端去旋转截骨术的患者。术前及术后1年时测量胫骨结节-股骨滑车沟距离、股骨前倾角等影像学参数,并采用髌骨应力像评估髌骨稳定性。术前和末次随访时评估临床功能评分(Kujala和Tegner评分)。结果:本研究共纳入44例患者,平均随访时间为6.5年,股骨前倾角由术前35.4°±3.5°改善至术后11.4°±1.2°,胫骨结节-股骨滑车沟距离由术前21.5±3.8 mm减小至术后14.5±3.4 mm。Kujala评分由术前平均58.4±9.4提高至术后89.3±6.3,Tegner评分由术前平均3.4±0.6改善至术后5.6±0.6,上述参数术后与术前差异均有统计学意义。髌骨应力像示术后有3例患者存在内侧髌股韧带残存松弛,在随访期间无患者发生髌骨再脱位或半脱位。结论:对于伴股骨前倾角增大(>30°)的复发性髌骨脱位患者,股骨远端去旋转截骨术联合内侧髌股韧带重建术能取得较好的中期临床疗效,术后无一例髌骨再脱位发生。Objective To explore the medium-term clinical outcomes of distal derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in treating recurrent patellar dislocation(RPD) with increased femoral anteversion(>30°). Methods RPD patients with a femoral anteversion angle of >30° and undergoing distal derotational femoral osteotomy between January 2015 to June 2016 were selected. Imaging parameters such as the tibial tubercle-trochlear groove distance and femoral anteversion angle were measured before and 1 year after the operation,and the stability of patella was evaluated using the patella stress image. Clinical functional scores(Kujala and Tegner scores)were assessed before the operation and at the final follow-up. Results In this study,a total of 44 patients were enrolled,with an average follow-up of 6.5 years. The average femoral anteversion angle,Kujala score and Tegner score increased significantly from preoperative 35.4° ± 3.5°,58.4 ± 9.4 and3.4 ± 0.6 to postoperative 11.4° ± 1.2°,89.3 ± 6.3 and 5.6 ± 0.6 respectively,while the average tibial tubercle-trochlear groove distance decreased significantly from 21.5 ± 3.8 mm preoperatively to 14.5± 3.4 mm postoperatively. There were 3 patients with medial patellofemoral ligament residual laxity after patellar stress imaging,and no patients had patellar redislocation or subluxation events during the follow-up. Conclusion For recurrent patellar dislocation patients with enlarged femoral anteversion angle(>30°),distal derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction can achieve good medium-term clinical outcomes,and no patellarre dislocation appears after the surgery.

关 键 词：复发性髌骨脱位 股骨前倾角 股骨远端去旋转截骨 移植物残存松弛 

分 类 号：R687.3[医药卫生—骨科学]