中国修复重建外科杂志

中国修复重建外科杂志

包含胫骨结节下移的联合手术治疗合并高位髌骨的复发性髌骨脱位

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目的探讨包含胫骨结节下移的联合手术治疗合并高位髌骨的复发性髌骨脱位的手术技术及临床疗效。方法2010 年 4 月—2016 年 5 月,采用包含胫骨结节下移的联合手术治疗 14 例合并高位髌骨的复发性髌骨脱位患者。男 5 例,女 9 例;年龄 13~26 岁,平均 18.5 岁。左膝 9 例,右膝 5 例。髌骨脱位 2~5 次,平均 3.3 次;首次脱位至该次就诊时间为 4~60 个月,平均 19.7 个月。患者主要症状为膝关节疼痛、活动受限。术前膝关节 X 线片、CT、MRI 检查示骺板均已闭合;3 例存在髌骨内缘撕脱性骨折,2 例关节腔内有游离体。比较手术前后胫骨结节-股骨滑车沟(tibial tuberosity-trochlear groove,TT-TG)间距、髌骨滑车沟间距、Caton-Deschamps 指数以及膝关节活动度、Lysholm 评分、国际膝关节文献委员会(IKDC)评分、Kujala 评分、Tegner 评分。结果术后切口均Ⅰ期愈合。所有患者均获随访,随访时间 24~72 个月,平均 34.6 个月。术后复查 X 线片及 CT 提示髌骨脱位均纠正;胫骨结节截骨移位处均愈合,愈合时间 3~5 个月,平均 3.8 个月。术后 1 d 及 1 年时 TT-TG 间距、髌骨滑车沟间距、Caton-Deschamps 指数与术前比较,差异均有统计学意义(P<0.05);术后 1 d 及 1 年比较,差异无统计学意义(P>0.05)。术后 1 年及 2 年时膝关节活动度、Lysholm 评分、IKDC 评分、Kujala 评分、Tegner 评分均优于术前(P<0.05);术后 1 年及 2 年比较,差异无统计学意义(P>0.05)。结论采用包含胫骨结节下移的联合手术治疗合并高位髌骨的复发性髌骨脱位,安全可靠,近期疗效满意。

ObjectiveTo explore the clinical effects of combined operation involving tibial tubercle distalization for the recurrent patellar dislocation with patella alta.MethodsBetween April 2010 and May 2016, 14 cases of recurrent patellar dislocation with patella alta were treated with combined operation involving tibial tubercle distalization. There were 5 males and 9 females with an average age of 18.5 years (range, 13-26 years). The left knee was involved in 9 cases and the right knee in 5 cases. The patella had dislocated 3.3 times on average (range, 2-5 times). The interval between the first dislocation and admission was 19.7 months on average (range, 4-60 months), and the main symptoms were knee pain and limited knee movement. Preoperative X-ray films, CT, and MRI examinations of knee joint showed that the epiphyseal plate closed in all patients. Of all patients, 3 patients had avulsion fracture of the inner edge of patella, and 2 patients had free body in articular cavity. The tibial tuberosity-trochlear groove (TT-TG) distance, patellar-trochlear-groove distance, Caton-Deschamps index, knee range of motion (ROM), Lysholm score, International Knee Documentation Committee (IKDC) score, Kujala score, and Tegner score were compared pre- and post-operation.ResultsAll patients had primary wound healing. All patients were followed up 24-72 months with an average of 34.6 months. X-ray film and CT examination showed that the patellar dislocation was corrected and the osteotomy of the tibial tubercle healed with an average healing time of 3.8 months (range, 3-5 month). At 1 day and 1 year after operation, the TT-TG distance, patellar-trochlear-groove distance, and Caton-Deschamps index showed significant differences when compared with preoperative values (P<0.05), but there was no significant difference between 1 day and 1 year after operation (P>0.05). At the 1 year and 2 years after operation, the knee ROM, Lysholm score, IKDC score, Kujala score, and Tegner score showed significant differences when compared with preoperative values (P<0.05), and there was no significant difference between the 1 year and 2 years after operation (P>0.05).ConclusionCombined operation involving tibial tubercle distalization is a safe and reliable method, which has satisfactory short-term effectiveness for the recurrent patellar dislocation with patella alta.

关键词: 复发性髌骨脱位; 高位髌骨; 胫骨结节下移; 临床疗效

Key words: Recurrent patellar dislocation; patella alta; tibial tubercle distalization; effectiveness

引用本文: 戴祝, 雷运亮, 廖瑛, 陈志伟, 符得红, 黎洲. 包含胫骨结节下移的联合手术治疗合并高位髌骨的复发性髌骨脱位. 中国修复重建外科杂志, 2019, 33(3): 312-317. doi: 10.7507/1002-1892.201808002 复制

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