中国修复重建外科杂志

中国修复重建外科杂志

内侧髌股韧带重建治疗复发性髌骨脱位

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目的 介绍采用内侧髌股韧带(medial patellofemoral ligament,MPFL)重建治疗复发性髌骨脱位的手术技术和效果。 方法 2005 年6 月- 2007 年9 月,采用MPFL 重建治疗复发性髌骨脱位29 例。男6 例,女23 例;年龄13 ~ 45 岁,平均20.3 岁。髌骨脱位2 ~ 10 次。末次髌骨脱位至手术时间为1 ~ 144 个月,平均43.9 个月。术前CT 检查测量胫骨结节- 股骨滑车间距(tibial tuberosity-trochlear groove distance,TT-TG);并行Kujala、Lysholm 和Tegner评分,分别为(72.03 ± 17.38)、(72.65 ± 14.70)、(5.25 ± 1.83)分。手术采用同种异体肌腱作为移植物,在股骨侧使用骨隧道技术,可吸收挤压螺钉固定;在髌骨内侧缘制作双L 形隧道,调节移植物张力后,缝合固定移植物的游离端。同时行关节镜检查、游离体取出和髌外侧支持带松解。对于TT-TG gt; 20 mm 的16 例患者,同时行胫骨结节内移截骨。 结果 27例获随访,随访时间40 ~ 67 个月,平均45.5 个月。患者术后均无髌骨再脱位,也无髌骨错动或半脱位。0° 位和屈膝30°位髌骨外推试验和外推恐惧试验均为阴性。术后1 年患者膝关节屈伸活动度均恢复正常,能够完全下蹲。末次随访时Kujala 评分、Lysholm 评分分别为(94.10 ± 7.59)、(95.44 ± 6.25)分,与术前比较差异均有统计学意义(P lt; 0.05);Tegner评分为(4.33 ± 1.00)分,与术前比较差异无统计学意义(t=1.302,P=0.213)。术前TT-TG gt; 20 mm 的患者末次随访时TTTG为(16.88 ± 5.92)mm,与术前(23.38 ± 3.70)mm 比较差异有统计学意义(t=2.822,P=0.026)。 结论 MPFL 重建治疗复发性髌骨脱位能够明显改善髌骨稳定性,且术后膝关节功能评分和运动等级评分均较术前明显改善。

Objective To investigate the procedure and effectiveness of medial patellofemoral l igament (MPFL) reconstruction for the treatment of recurrent patellar dislocation. Methods Between June 2005 and September 2007, 29 patients with recurrent patellar dislocation underwent MPFL reconstruction with allograft semitendinosus or allograft anterior tibial is tendon. There were 6 males and 23 females with an average age of 20.3 years (range, 13-45 years). The patients suffered
from 2-10 times patellar dislocation preoperatively. The average time between last dislocation and surgery was 43.9 months (range, 1-144 months). CT scan was performed to measure the tibial tuberosity-trochlear groove distance (TT-TG). The femoral tunnel was made at the origin of MPFL insertion, just inferior to the medial epicondyle. The double L-shape patellar tunnels were made on the medial rim of patella with 4.5 mm in diameter. The loop side of the graft was fixed with a bioabsorbable interference screw in the femoral tunnel both ends of the graft. For the TT-TG was more than 20 mm, a modified Elmsl ie-Trillat osteotomy was performed to correct the distal al ignment of patella. The arthroscopic examination was also performed for loosebody and lateral retinacular release. Results Twenty-seven patients were followed up 45.5 months on average (range, 40-67 months). No recurrent dislocation or subdislocation occurred. All the patients showed negative apprehension test at 0° and 30° flexions of knee. The range of motion of knee restored normal 1 year after operation. The Kujala score was improved from 72.03 ± 17.38 preoperatively to 94.10 ± 7.59 postoperatively, and Lysholm score was improved from 72.65 ± 14.70 to 95.44 ± 6.25, both showing significant differences (P lt; 0.05). The Tegner score was decreased from 5.25 ± 1.83 preoperatively to 4.33 ± 1.00 postoperatively, showing no significant difference (t=1.302, P=0.213). In patients whose TT-TG was more than 20 mm, TTTG was decreased from (23.38 ± 3.70) mm to (16.88 ± 5.92) mm at last follow-up, showing significant difference (t=2.822,
P=0.026). Conclusion The technique of MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the patella stabil ity and knee function.

关键词: 复发性髌骨脱位; 内侧髌股韧带重建; 胫骨结节内移截骨; 外侧支持带松解

Key words: Recurrent patellar dislocation; Medial patellofemoral ligament reconstruction; Elmsl ie-Trillat osteotomy; Lateral retinacular release

引用本文: 张辉,洪雷,耿向苏,王雪松,冯华. 内侧髌股韧带重建治疗复发性髌骨脱位. 中国修复重建外科杂志, 2011, 25(8): 925-930. doi: 复制

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