膝关节镜辅助下内侧髌股韧带重建与开放性内侧支持带紧缩治疗青少年复发性髌骨脱位疗效及并发症分析  

Effect and complications of knee arthroscopic MPFL reconstruction and open medial retinaculum plication in the treatment of adolescents with recurrent patellar dislocation

作　　者：刘志磊 王薪华[1] 陈明新[1] 张力 杨明明 唐丽 成康 赵炜[1] 孙根发[1] LIU Zhilei;WANG Xinhua;CHEN Mingxin;ZHANG Li;YANG Mingming;TANG Li;CHENG Kang;ZHAO Wei;SUN Genfa(Department of Orthopedics,Ankang Central Hospital,Ankang 725000,Shanxi,China;Department of Rehabilitation,Ankang Central Hospital,Ankang 725000,Shanxi,China)

机构地区：[1]安康市中心医院骨科,陕西安康725000 [2]安康市中心医院康复科,陕西安康725000

出　　处：《西部医学》2024年第8期1170-1174,共5页Medical Journal of West China

基　　金：陕西省重点研发计划项目(2022SF-009);陕西省安康市科技局2022年项目(AK2022-SFZC-01)。

摘　　要：目的观察膝关节镜辅助下内侧髌股韧带(MPFL)重建与开放性内侧支持带紧缩治疗青少年复发性髌骨脱位疗效及分析并发症。方法回顾性分析2020年9月—2022年1月我院收治的复发性髌骨脱位的58例患者。根据治疗方式分为支持带紧缩组(n=31)和韧带重建组(n=27),支持带紧缩组行开放性内侧支持带紧缩术,韧带重建组行膝关节镜辅助下MPFL重建术。分析比较两组患者髌骨恐惧试验、影像学检查结果[髌骨移动度及髌骨外侧角、髌骨适合角、髌骨倾斜角]、疼痛情况[视觉疼痛评分(VAS)]及膝关节功能评分[Lysholm膝关节功能评分量表评分(LKSS)]、[Kujala髌股关节功能评分(KPS)]及并发症。结果治疗后,两组髌骨移动度及髌骨外侧角、髌骨适合角、髌骨倾斜角均有所降低,且韧带重建组均小于支持带紧缩组(P<0.05);术后末次随访,韧带重建组髌骨恐惧试验均为阴性,支持带紧缩组阳性率9.68%,两组阳性率比较差异无统计学意义(P>0.05);治疗后3 d,两组VAS评分均有所升高,但韧带重建组低于支持带紧缩组(P<0.05);治疗后,两组LKSS评分和KPS评分均有所增加,且韧带重建组评分均高于支持带紧缩组(P<0.05);治疗后,韧带重建组并发症发生率7.41%低于支持带紧缩组29.03%(P<0.05)。结论膝关节镜辅助下内侧MPFL韧带重建治疗青少年复发性髌骨脱位具有良好的治疗效果,能够促进膝关节功能恢复,降低术后疼痛度,减少并发症发生率。Objective To observe the curative effect of knee arthroscopic medial patellofemoral ligament(MPFL)reconstruction and open medial retinaculum plication on adolescents with recurrent patellar dislocation,and analyze the complications.Methods A total of 58 patients with recurrent patellar dislocation admitted to the hospital were enrolled as the research objects from September 2020 to January 2022 were retrospectively analyzed.According to different treatment methods,they were divided into retinaculum plication group(n=31,open medial retinaculum plication)and ligament reconstruction group(n=27,knee arthroscopic MPFL reconstruction).The results of patellar fear test and imaging examinations[patellar mobility,lateral patellofemoral angle,congruence angle,patellar tilt angle],scores of pain[visual analogue scale(VAS)],knee function[Lysholm knee scoring scale(LKSS)]and Kujala patellofemoral function[Kujala performance scale(KPS)],and complications in the two groups were analyzed and compared.Results After treatment,patellar mobility,lateral patellofemoral angle,congruence angle and patellar tilt angle were decreased in both groups,which were lower in ligament reconstruction group than retinaculum plication group(P<0.05).At the last follow-up,there was no significant difference in positive rate of patellar fear test between ligament reconstruction group and retinaculum plication group(0.00%vs 9.68%,P>0.05).At 3d after treatment,VAS scores in both groups were increased,which were lower in ligament reconstruction group than retinaculum plication group(P<0.05).After treatment,Lysholm and Kujala scores were increased in both groups,which were higher in ligament reconstruction group than retinaculum plication group(P<0.05).After treatment,incidence of complications in ligament reconstruction group was lower than that in retinaculum plication group(7.41%vs 29.03%,P<0.05).Conclusion The curative effect of knee arthroscopic MPFL reconstruction is good on adolescents with recurrent patellar dislocation,which can promote the recov

关 键 词：复发性髌骨脱位 内侧髌股韧带重建 内侧支持带紧缩术 青少年 膝关节镜辅助 

分 类 号：R684.7[医药卫生—骨科学]