胫骨结节-股骨滑车沟间距对单纯内侧髌股韧带重建治疗复发性髌骨脱位临床疗效的影响  

The Influence of Tibial Tubercle-Trochlear Groove Distance on Isolated Medial Patellofemoral Ligament Reconstruction Treating Recurrent Patellar Dislocation

作　　者：胡枫艺 杨帅 孟庆阳[1] 陈拿云 王佳宁[1] 马勇[1] 刘平[1] 王成[1] 史尉利 Hu Fengyi;Yang Shuai;Meng Qingyang;Chen Nayun;Wang Jianing;Ma Yong;Liu Ping;Wang Cheng;Shi Weili(Department of Sports Medicine,Peking University Third Hospital,Institute of Sports Medicine of Peking University,Beijing Key Laboratory of Sports Injuries,Beijing 100191,China)

机构地区：[1]北京大学第三医院运动医学科,北京大学运动医学研究所,运动医学关节伤病北京市重点实验室,北京100191

出　　处：《中国运动医学杂志》2022年第10期752-758,共7页Chinese Journal of Sports Medicine

基　　金：北京市科技新星项目(Z201100006820011);国家自然科学基金青年项目(81902208)。

摘　　要：目的:探究胫骨结节-股骨滑车沟(tibial tubercle-trochlear groove,TT-TG)间距对单纯内侧髌股韧带(medial patellofemoral ligament,MPFL)重建治疗复发性髌骨脱位临床疗效的影响。方法:回顾2014年1月至2020年8月间接受MPFL双束重建的复发性髌骨脱位成人患者的临床资料。测量TT-TG距离、Insall-Salvati指数、Dejour分型和髌骨倾斜角。以TT-TG距离20 mm为临界值,分为正常组和增大组,对比两组间术前和术后IKDC、Kujala、Lysholm和Tegner评分,评估运动恢复情况及术后并发症。结果:共纳入53例患者(58膝)。平均随访50.0±20.9个月。末次随访时,TT-TG距离正常组和增大组内IKDC、Kujala、Lysholm、Tegner评分较术前均有显著提高(P<0.001),两组间术后功能评分的差异无统计学意义(P>0.05)。TT-TG距离正常组和增大组运动恢复率分别达到88.0%和94.4%。两组内术后髌骨倾斜角较术前明显减小(P<0.001),但组间无显著差异(P=0.787)。TT-TG距离增大组中1例患者术后再发半脱位;两组均未出现关节僵硬、感染或髌骨骨折。结论:单纯MPFL重建治疗合并TT-TG值增大的复发性髌骨脱位短期临床疗效满意;对于TT-TG值≥20 mm与TT-TG值正常的复发性髌骨脱位患者,单纯MPFL重建的疗效无显著差异。ObjectiveTo explore the impact of tibial tubercle-trochlear groove(TT-TG) distance on isolated medial patellofemoral ligament(MPFL) reconstruction treating recurrent patellar dislocation.MethodsA retrospective review was carried out among adult patients who underwent double-bundle MPFL reconstruction between January 2014 and August 2020. Their TT-TG distance, Insall-Salvati index,Dejour classification and patellar tilt were measured. Patients with TT-TG distance<20 mm were chosen into the normal group,while those with the value≥ 20 mm were selected into an enlargement group. The preoperative and postoperative knee function scores were compared between the two groups,including International Knee Documentation Committee(IKDC),Kujala,Lysholm and Tegner scores. Information regarding returning-to-sport and complications was collected.ResultsA total of 58 MPFL reconstructions in 53 patients were included,with an average follow-up of 50.0 ± 20.9 months. At the last follow-up,there were significant improvements in the average IKDC,Kujala,Lysholm and Tegner scores of both groups(P<0.001),but no significant differences were observed between the two groups after the operation(P>0.05). The return-to-sport rates of the normal TT-TG group and the enlargement group were 88.0% and 94.4% respectively. Moreover, the patellar tilt decreased significantly in both groups(P<0.001), but without significant difference between them(P=0.787). In the enlargement group,one patient experienced a postoperative subluxation. However,no cases of arthrofibrosis,patella fracture and infection were found in both groups.ConclusionIsolated MPFL reconstruction yields satisfactory short-term outcomes in treating recurrent patellar dislocation patients with TT-TG distance no less than 20 mm. However,for patients with a TT-TG distance≥ 20 mm and those with a TT-TG distance within the normal range,no significant differences were observed by mere MPFL reconstruction.

关 键 词：复发性髌骨脱位 单纯内侧髌股韧带重建 胫骨结节-股骨滑车沟间距 胫骨结节外移 高位髌骨 

分 类 号：R687.3[医药卫生—骨科学]