髌骨骨道定位器在内侧髌股韧带重建术中的临床应用  

Clinical application and effectiveness of patellar tunnel locator in medial patellofemoral ligament reconstruction surgery

作　　者：陈昊 张有磊 邢朝辉 张柏青 潘文琦 孙宝亭 甄志雷 徐寒 王志樱 CHEN Hao;ZHANG Youlei;XING Chaohui;ZHANG Baiqing;PAN Wenqi;SUN Baoting;ZHEN Zhilei;XU Han;WANG Zhiying(The Second Department of Orthopedics,Beijing DCN Orthopedic Hospital,Beijing,100143,P.R.China)

机构地区：[1]北京德尔康尼骨科医院骨二科,北京100143

出　　处：《中国修复重建外科杂志》2023年第10期1230-1237,共8页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 评价一款自行研发的髌骨骨道定位器(以下简称“定位器”)在内侧髌股韧带(medial patellofemoral ligament,MPFL)重建术中的可操作性和有效性。方法 选择2022年1月—12月收治且符合选择标准的38例复发性髌骨脱位患者,随机分为研究组(MPFL重建术中使用定位器建立髌骨骨道)和对照组(MPFL重建术中不使用定位器),每组19例。两组患者性别、年龄、身体质量指数、病程、髌骨Wiberg分型、软骨损伤构成比、Caton指数、胫骨结节-股骨滑车间距及术前Lysholm评分、Kujal评分、Tegner评分和疼痛视觉模拟评分(VAS)等基线资料比较,差异均无统计学意义(P>0.05)。术前及术后3 d,1、3、6个月采用Lysholm评分、Kujal评分、Tegner评分和VAS评分进行膝关节功能评价。测量术前模拟的理想髌骨骨道前侧皮质厚度、骨道长度及术后实际髌骨骨道前侧皮质厚度及骨道长度,并计算D1(理想入口与实际入口距离)、D2(理想骨道长度-实际骨道长度)、D3(理想前侧皮质厚度-实际前侧皮质厚度)。结果 两组患者均获随访,随访时间6~8个月,平均6.7个月。研究组切口长度和术中出血量小于对照组,但手术时间明显长于对照组,差异均有统计学意义(P<0.05)。两组患者均未出现切口感染、积液、延迟愈合等并发症,随访期间无再发脱位情况;研究组1例患者术后出现鹅足区持续疼痛,经局部理疗后症状缓解。两组患者术后3 d VAS评分较术前大幅增长,随时间延长逐渐降低;Lysholm评分、Kujal评分和Tegner评分变化趋势与VAS评分相反。组间比较除研究组术后3 d Lysholm评分和Kujal评分高于对照组,术后3 d、1个月VAS评分低于对照组,差异有统计学意义(P<0.05)外,其余各时间点两组间各评分比较差异均无统计学意义(P>0.05)。髌骨骨道评价示,两组术前模拟理想髌骨骨道长度、前侧皮质厚度及术后实际骨道长度差异均无统计学意义(P>0.05)Objective To evaluate the operability and effectiveness of a self-developed patellar bone canal locator(hereinafter referred to as“locator”)in the reconstruction of the medial patellofemoral ligament(MPFL).Methods A total of 38 patients with recurrent patellar dislocation who met the selection criteria admitted between January 2022 and December 2022 were randomly divided into study group(the patellar canal was established with a locator during MPFL reconstruction)and control group(no locator was used in MPFL reconstruction),with 19 cases in each group.There was no significant difference in baseline data between the two groups(P>0.05),such as gender,age,body mass index,disease duration,patella Wiberg classification,constituent ratio of cartilage injury,Caton index,tibia tubercle-trochlear groove,and preoperative Lysholm score,Kujal score,Tegner score,visual analogue scale(VAS)score,and so on.The Lysholm score,Kujal score,Tegner score,and VAS score were used to evaluate knee joint function before operation and at 3 days,1 month,3 months,and 6 months after operation.The ideal prepatellar cortical thickness and canal length were measured before operation,and the actual prepatellar cortical thickness and canal length after operation were also measured,and D1(the distance between the ideal entrance and the actual entrance),D2(the ideal canal length minus the actual canal length),D3(the ideal prepatellar cortical thickness minus the actual prepatellar cortical thickness)were calculated.Results Patients in both groups were followed up 6-8 months(mean,6.7 months).The incision length and intraoperative blood loss in the study group were smaller than those in the control group,but the operation time was longer than that in the control group,the differences were significant(P<0.05).There was no complication such as incision infection,effusion,and delayed healing in both groups,and no further dislocation occurred during follow-up.One patient in the study group had persistent pain in the anserine area after operation,and t

关 键 词：复发性髌骨脱位 内侧髌股韧带重建术 髌骨骨道 定位器 

分 类 号：R687.3[医药卫生—骨科学]