关节镜下外侧支持带松解术联合小切口MPFL-R术治疗复发性髌骨脱位疗效观察  

Clinical efficacy of small incision lengthening and arthroscopic release of lateral retinaculum combined with MPFL-R in the treatment of recurrent dislocation of patella

作　　者：王琦 柯贤鹏 WANG Qi;KE Xian-peng(Department of Joint Surgery,Shangluo Central Hospital,Shangluo 726200,Shaanxi,CHINA)

机构地区：[1]商洛市中心医院关节外科,陕西商洛726200

出　　处：《海南医学》2023年第21期3108-3113,共6页Hainan Medical Journal

基　　金：2021年陕西省商洛市卫生健康委员会立项项目(编号:SL20211118)。

摘　　要：目的探讨小切口延长与关节镜下外侧支持带松解术(RLR)联合髌股韧带重建(MPFLR)术治疗复发性髌骨脱位(RDP)的效果。方法回顾性分析2017年3月至2018年1月商洛市中心医院收治的132例RDP患者的临床资料,根据治疗方法分组,其中54例实施开放性内侧支持带紧缩术(MRP)者记为A组,78例实施小切口延长与关节镜下RLR联合MPFLR术者记为B组。术后6个月、12个月复查。比较两组患者的手术指标、胫骨结节股骨滑车沟(TTTG)距离、适合角及外侧髌骨角、膝关节活动度(ROM)、股四头肌及股内侧肌肌力、膝关节与髋关节功能及并发症发生情况。结果B组患者的术中出血量、手术时间、住院时间分别为(65.74±13.12)mL、(1.31±0.26)h、(9.32±1.71)d,明显少(短)于A组的(89.82±17.85)mL、(1.85±0.37)h、(12.46±2.83)d,差异均具有统计学意义(P<0.05);两组患者术后6个月、12个月TTTG距离均短于术前,且B组患者术后6个月、12个月的TTTG距离分别为(12.63±0.22)mm、(15.80±0.24)mm,A组分别为(12.95±0.23)mm、(15.79±0.22)mm,差异均具有统计学意义(P<0.05);两组患者术后6个月、12个月适合角、外侧髌骨角、ROM、股四头肌及股内侧肌肌力、Lysholm评分、Kujala评分均大于术前,且B组患者术后6个月和12个月的上述各项指标均大于A组,差异均有统计学意义(P<0.05);B组患者的并发症总发生率为7.69%,明显低于A组的25.93%,差异具有统计学意义(P<0.05)。结论小切口延长与关节镜下RLR联合MPFLR术治疗RDP创伤小、效果好且安全性较高。Objective To explore the effect of small incision lengthening and arthroscopic release of lateral retinaculum(RLR)combined with medial patellofemoral ligament reconstruction(MPFLR)in the treatment of recurrent dislocation of patella(RDP).Methods The clinical data of 132 RDP patients treated in Shangluo Central Hospital from March 2017 to January 2018 were retrospectively analyzed.According to treatment methods,54 cases who underwent open medial retinaculum tightening surgery(MRP)were recorded as group A,and 78 cases who underwent small incision lengthening and arthroscopic RLR combined with MPFLR were recorded as group B.The patients were followed up at 6 and 12 months after operation.The surgical indexes of the two groups were compared,as well as the distance between the tibial tubercle and the femoral trochlear groove(TTTG),the angle of fit and the lateral patellar angle,the range of motion(ROM)of the knee joints,the strength of the quadriceps and vastus medialis muscles,the functions of the knee and hip joints and complications.Results The intraoperative blood loss,operation time,and length of hospital stay in group B were(65.74±13.12)mL,(1.31±0.26)h,(9.32±1.71)d,respectively,which were significantly less/shorter than(89.82±17.85)mL,(1.85±0.37)h,(12.46±2.83)d,respectively in group A(P<0.05).The TTTG distances after 6 and 12 months of operation in the two groups were significantly shorter than before operation,and the distances were(12.63±0.22)mm,(15.80±0.24)mm in group B versus(12.95±0.23)mm,(15.79±0.22)mm in group A,with statistically significant differences between the two groups(P<0.05).The suitable angle and lateral patella angle,ROM of knee joint,muscle strength of quadriceps femoris and medial femoris,Lysholm scores,and Kujala scores after 6 and 12 months of operation in the two groups were significantly higher than those before operation(P<0.05),and the above indicators of group B at 6 months and 12 months after surgery were significantly higher than those of group A(P<0.05).The incidence of c

关 键 词：复发性髌骨脱位 关节镜 外侧支持带松懈术 髌股韧带重建术 小切口 疗效 

分 类 号：R684.7[医药卫生—骨科学]