浅隧道双线环固定重建内侧髌股韧带  

Double shallow patellar tunnels and suture loops fixation for medial patellofemoral ligament reconstruction

作　　者：周明[1] 龚礼 侯慧铭[1] 邹文 范少勇[1] 胡梁深 ZHOU Ming;GONG Li;HOU Hui-ming;ZOU Wen;FAN Shao-yong;HU Liang-shen(Nanchang Hongdu Hospital of Traditional Chinese Medicine,Nan-chang 330008,China)

机构地区：[1]南昌市洪都中医院,江西南昌330008

出　　处：《中国矫形外科杂志》2024年第12期1137-1141,共5页Orthopedic Journal of China

摘　　要：[目的]介绍浅隧道双线环固定术重建内侧髌股韧带(medial patellofemoral ligament,MPFL)的手术技术和初步临床结果。[方法]2021年1月—2022年1月,对30例髌骨脱位患者采用浅隧道双线环固定MPFL重建。首先于髌骨内侧上和体部定位,钻入2枚带尾孔导针至对侧,使用4.5 mm空心钻沿带尾孔导针制作两个深约5 mm的浅隧道。利用带尾孔导针两骨道各引入1根引线。再用引线将对折的2根线环反向引入双隧道。将肌腱移植物置于2个线环中,分别收紧线环,将肌腱移植物引入浅隧道,紧密贴合后,打结固定。将肌腱移植物经深筋膜下引至股侧切口,制作股骨隧道,将移植物引入,适当张力下,挤压螺钉固定。[结果]所有患者均顺利完成手术,无严重并发症,随访12~24个月。与术前相比,末次随访时膝关节活动度[(63.3±18.2)°,(121.4±4.7)°,P<0.001]、VAS评分[(6.4±0.9),(1.9±0.5),P<0.001]、IKDC评分[(38.2±6.5),(79.9±5.3),P<0.001]、髌骨倾斜角[(23.7±4.2)°,(12.1±3.2)°,P<0.001]及髌骨适合角[(18.9±3.1)°,(-5.5±1.3)°,P<0.001]均显著改善。[结论]浅隧道双线环固定术重建内侧髌股韧带治疗髌骨脱位或半脱位可减少医源性损伤,取得良好临床疗效。[Objective]To present the surgical technique and preliminary clinical outcomes of double shallow patellar tunnels and su-ture loops fixation for medial patellofemoral ligament reconstruction.[Methods]From January 2021 to January 2022,30 patients with patel-lar dislocation were treated with abovementioned MPFL reconstruction.After location on the medial edge of the patella,two guide pins withtail holes were transversely drilled into the opposite side.Two shallow tunnels 5mm in depth were created by a cannulated drill 4.5 in diam-eter over the guide pins.Use a guide pin with a tail hole,leading PDS suture was introduce into each bone tunnel.Then,using the leadingPDS,two suture loops was induced into both bone tunnels.As the tendon graft was placed into two suture loops,the suture ends were tight-ened simultaneously to fit tendon graft into the shallow tunnels and fixed with knots.The tendon graft was led under the deep fascia to thefemoral incision,the femoral tunnel was made,the graft was introduced,and an interference screw was inserted to fix the reconstructed MP-FL in appropriate tension.[Results]All the patients had MPFL reconstructed successfully without serious complications,and were followedup for 12 to 24 months.Compared with those preoperatively,knee range of motion(ROM)[(63.3±18.2)°,(121.4±4.7)°,P<0.001],VAS score[(6.4±0.9),(1.9±0.5),P<0.001],IKDC scores[(38.2±6.5),(79.9±5.3),P<0.001],patellar tilt[(23.7±4.2)°,(12.1±3.2)°,P<0.001]and patel-lar congruency angle[(18.9±3.1)°,(-5.5±1.3)°,P<0.001]are improved significantly at the last follow-up.[Conclusion]Reconstruction ofmedial patellofemoral ligament with double shallow tunnels and double suture loops fixation did reduce iatrogenic trauma and achieve goodclinical consequences for patella dislocation or subluxation.

关 键 词：髌骨脱位或半脱位 内侧髌股韧带重建 浅隧道 双线环 

分 类 号：R687[医药卫生—骨科学]