股骨后髁角对内侧髌股韧带重建治疗复发性髌骨脱位疗效的影响  

Influence of posterior condylar angle on medial patellofemoral ligament reconstruction for recurrent patellar dislocation

作　　者：张镭 文印宪[1] 倪曲波 陈廖斌[1] ZHANG Lei;WEN Yinxian;NI Qubo;CHEN Liaobin(Dept.of Orthopaedic Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学中南医院骨科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第1期68-73,共6页Medical Journal of Wuhan University

摘　　要：目的:探讨股骨后髁角(PCA)对复发性髌骨脱位(RPD)患者行内侧髌股韧带(MPFL)重建术疗效的影响。方法:选2017年7月—2022年7月间符合纳入标准的复发性髌骨脱位患者38例(39膝),这些患者均行MPFL重建术,为了减少股骨滑车形态对结果的影响,按Dejour分型,将患者分为正常滑车组20例,滑车发育不良组(Dejour分型A、B、C、D型分别为4、2、12、1例)19例;以上2组按照后髁角大小,分为非大后髁角组(PCA<3.82?)、大后髁角组(PCA≥3.82?),比较这些患者围手术期、末次随访等资料。结果:各组病人间术前年龄、体质量指数(BMI)、髌韧带与髌骨长径之比(ISR)、胫骨结节-滑车沟距离(TT-TG)、滑车沟角(SA)、髌骨倾斜角(PTA)、外侧滑车倾斜角(LTI)差异均无统计学意义;术后住院天数、末次随访时长无统计学差异。所有病人均接受外侧髌股韧带松解及MPFL重建手术,术后平均随访31.3个月,4组患者术后均未出现髌骨脱位,无严重并发症。末次随访,Kujala评分、Lysholm评分、Tegner评分均较术前显著增加(P<0.05),但相同滑车不同后髁角组间术前、术后均无明显差异(P>0.05)。结论:MPFL重建术对RPD中期疗效满意,PCA对手术效果无明显影响。Objective:To explore the correlation between posterior condylar angle(PCA)and clinical out-come of medial patellofemoral ligament(MPFL)reconstruction recurrent patellar dislocation.Methods:A total of 38 recurrent patellar dislocation(RPD)patients(39 knees)undergoing MPFL re-construction from July 2017 to July 2022 were included.The biases from femoral trochlear morpholo-gy were controlled by dividing these knees into two groups,the normal trochlea with 20 knees and trochlear dysplasia with 19 knees;then another two cohorts(PCA<3.82˚and PCA≥3.82˚)were grouped in each trochlea-divided group.Perioperative and last follow-up data were compared between the four groups.Results:There were no significant differences in gender,affected side,age,body mass index(BMI),Insll-Salvati index(ISR),tibial tuberosity-trochlea groove distance(TT-TG),sul-cus angle(SA),patellar tilt angle(PTA),lateral trochlear inclination(LTI),hospital stay and follow up period among the groups(P>0.05).All the patients underwent MPFL reconstruction combined with lateral retinaculum release during an average of 31.3 months follow-up after the surgery.None of the patients had patellar dislocation or severe postoperative complications.Kujala scores,Lysholm scores,and Tegner scores were increased in all groups(P<0.05),which shows no significant differ-ence between PCA-divided groups in the same trochlea group(P>0.05).Conclusion:MPFL recon-struction does achieve satisfactory mid-term clinical outcomes for RPD,which is not impacted remark-ably by PCA.

关 键 词：复发性髌骨脱位 内侧髌股韧带 关节重建 股骨后髁角 

分 类 号：R684.7[医药卫生—骨科学]