改良式髌骨单隧道内侧髌股韧带重建治疗复发性髌骨脱位的疗效分析  

Effectiveness of modified single patellar tunnel medial patella femoral ligament reconstruction for recurrent patellar dislocation

作　　者：王国梁[1] 李黎[1] 王凡 戴一像 李骅[1] 施青吕 WANG Guoliang;LI Li;WANG Fan;DAI Yixiang;LI Hua;SHI Qinglü(Department of Sports Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming Yunnan,650032,P.R.China)

机构地区：[1]昆明医科大学第一附属医院运动医学科,昆明650032

出　　处：《中国修复重建外科杂志》2025年第1期20-25,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：云南省科技厅技术创新人才培养对象项目(202205AD160007)。

摘　　要：目的探讨改良式髌骨单隧道内侧髌股韧带(medial patella femoral ligament,MPFL)重建治疗复发性髌骨脱位的临床疗效。方法2023年1月—6月,共纳入61例拟行自体半腱肌重建MPFL治疗的复发性髌骨脱位患者,按随机数字表法分成2组,31例采用髌骨内侧双锚钉MPFL重建(髌骨锚钉组),30例采用髌骨单隧道MPFL重建(髌骨隧道组),两组股骨端均采用可吸收挤压螺钉固定。两组患者性别、年龄、侧别、胫骨结节至滑车沟距离(tibial tubercle-trochlear groove,TT-TG)、Q角、Caton-Deschamps指数、脱位次数及术前Kujala评分、术前髌骨倾斜角等基线资料比较差异均无统计学意义(P>0.05)。术后复查膝关节CT观察髌骨骨道、髌骨锚钉位置及髌骨复位情况,同时测量髌骨倾斜角;术前,术后2周及1、3、6、12个月采用Kujala评分评估膝关节功能恢复情况;术后3个月行切口美观满意度评分;术后12个月复查膝关节MRI测量移植肌腱信噪比(signal-tonoise quotient,SNQ)比较两组患者移植物的成熟度。结果两组手术时间、术中出血量比较差异无统计学意义(P>0.05)。膝关节CT复查示髌骨骨道、髌骨锚钉位置与术中透视定位一致;两组髌骨倾斜角手术前后差值比较差异无统计学意义(P>0.05)。两组患者均获随访,随访时间12~14个月,平均12.8个月。髌骨锚钉组有1例髌骨端锚钉缝线排斥反应,经清创换药后切口愈合。随访期间患者均无髌骨脱位复发、感染、术后僵硬等相关并发症发生。两组患者术后1个月后各时间点Kujala评分均较术前显著改善(P<0.05),术后3个月均恢复至正常水平。术后极早期(2周时)髌骨隧道组Kujala评分高于髌骨锚钉组,差异有统计学意义(P<0.05),其余时间点两组间比较差异均无统计学意义(P>0.05)。髌骨隧道组患者术后3个月切口美观满意度评分及术后12个月SNQ显著优于髌骨锚钉组(P<0.05)。结论采用改良式髌骨单隧道MPFL重建治Objective To investigate the effectiveness of modified single patellar tunnel medial patella femoral ligament(MPFL)reconstruction in the treatment of recurrent patellar dislocation.Methods Between January 2023 and June 2023,a total of 61 patients with recurrent patellar dislocation who underwent MPFL reconstruction with autologous semitendinosus were enrolled and divided into 2 groups using random number table method.In the patellar anchor group,31 patients were treated with MPFL reconstruction with double medial patellar anchors,and 30 patients in the patellar tunnel group were treated with MPFL reconstruction with single patellar tunnel.The femoral ends of both groups were fixed with absorbable compression screws.There was no significant difference in baseline data such as gender,age,side,tibial tubercle-trochlear groove(TT-TG),Q angle,Caton-Deschamps index,number of dislocation,and preoperative Kujala score,preoperative patellar inclination angle(P>0.05).Patellar tunnel,patellar anchor position,patellar reduction,and the patellar inclination angle were measured by CT scan after operation.Kujala score was used to evaluate the function of knee joint before operation,at 2 weeks and 1,3,6,12 months after operation.Incision aesthetic satisfaction score was performed at 3 months after operation.The signal-to-noise quotient(SNQ)of the transplanted tendon was measured by knee MRI at 12 months after operation to compare the maturity of the graft between the two groups.Results There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).Knee CT reexamination showed that the patellar tunnel and the patellar anchor position were consistent with the intraoperative fluoroscopy.There was no significant difference in the difference of the patellar inclination angle between the two groups before and after operation(P>0.05).All patients were followed up 12-14 months(mean,12.8 months).There was 1 case of patellar anchor suture rejection in patellar anchor group,and the wound

关 键 词：内侧髌股韧带重建 复发性髌骨脱位 髌骨隧道 

分 类 号：R687.3[医药卫生—骨科学]