关节镜下双束等距重建内侧髌股韧带联合胫骨结节移位术治疗复发性髌骨脱位  

Arthroscopic double-bundle isometric reconstruction of medial patellofemoral ligament combined with tibial tubercle transfer on recurrent patellar dislocation

作　　者：张文豪 高健[1] 牟利民 王书华 沈志敏[1] 艾尔西丁·阿不来提[1] 袁智宇 ZHANG Wen-hao;GAO Jian;MOU Li-min;WANG Shu-hua;SHEN Zhi-min;Aierxiding Abulaiti;YUAN Zhi-yu(Dept of Joint Surgery,the Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830000,China)

机构地区：[1]新疆医科大学第六附属医院关节外科,新疆乌鲁木齐830000 [2]驻马店市骨科医院创伤矫形科,河南驻马店463003

出　　处：《临床骨科杂志》2022年第6期868-872,共5页Journal of Clinical Orthopaedics

基　　金：新疆维吾尔自治区自然科学基金(编号:2019D01C246)。

摘　　要：目的探讨关节镜下双束等距重建内侧髌股韧带联合胫骨结节移位术治疗复发性髌骨脱位的疗效。方法采用关节镜下双束等距重建内侧髌股韧带联合胫骨结节移位术治疗36例复发性髌骨脱位患者。记录胫骨结节-股骨滑车(TT-TG)间距、髌股适合角(PCA)、髌骨倾斜角(PTA),采用恐惧试验评估髌股关节稳定性,采用Kujala评分及Lysholm评分评估膝关节功能。结果患者均获得随访,时间15~22个月。随访期间未出现髌骨再脱位,髌骨恐惧试验均为阴性。末次随访时,患者行走、跑跳均正常,可参与正常体育活动;4例诉气温降低时,截骨处轻微不适,未给予特殊处理;1例术后3个月屈膝功能受限,给予麻醉下膝关节松解术。PCA、PTA、TT-TG间距:末次随访均明显小于术前(P<0.05)。Lysholm评分及Kujala评分:术后3个月、末次随访均明显大于术前(P<0.05)。结论关节镜下双束等距重建内侧髌股韧带联合胫骨结节移位术治疗复发性髌骨脱位,可在术中确定移植物的等距性,有效恢复髌股关节的稳定性,改善患者术后运动功能。Objective To investigate the efficacy of arthroscopic double-bundle isometric reconstruction of the medial patellofemoral ligament(MPFL)combined with tibial tubercle transfer in the treatment of recurrent patellar dislocation.Methods Thirty-six patients with recurrent patellar dislocation were treated with arthroscopic double-bundle isometric reconstruction of MPFL combined with tibial tubercle transfer.Tibial tubercle-trochlear groove(TT-TG)distance,patellofemoral conformation angle(PCA),and patellar tilt angle(PTA)were recorded.Patellar apprehension test was used to evaluate patellofemoral joint stability,and Kujala score and Lysholm score were used to evaluate knee joint function.Results All patients were followed up for 15~22 months.There was no patellar redislocaiton during the follow-up,and the patellar apprehension test was negative.At the last follow-up,the patients′walking,running and jumping were normal,and they could participate in normal sports activities;4 cases complained of slight discomfort at the osteotomy site when the temperature dropped,and were not given special management;1 case had limited knee flexion function at 3 months after operation,and underwent knee joint release under anesthesia.PCA,PTA and TT-TG distance:at the last follow-up,which were significantly smaller than the preoperation(P<0.05).Lysholm scores and Kujala scores:at 3 months postoperation and last follow-up,they were significantly higher than the preoperation(P<0.05).Conclusions Arthroscopic double-bundle isometric reconstruction of MPFL combined with tibial tubercle transfer for recurrent patellar dislocation can determine the isometricity of the graft intraoperatively,effectively restoring the stability of the patellofemoral joint,and improving the patient′s sports function after surgery.

关 键 词：复发性髌骨脱位 内侧髌股韧带 等距重建 胫骨结节移位术 半腱肌 关节镜检查 

分 类 号：R684.7[医药卫生—骨科学] R687.4[医药卫生—外科学]