摘要
目的探讨同种异体肌腱双束解剖重建膝关节内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗髌骨脱位的临床疗效。方法2005年9月-2008年6月,收治髌骨脱位20例。男4例,女16例;年龄13～31岁,平均19岁。左膝7例,右膝13例。病程1d～2年;其中急性脱位6例,复发性脱位14例。脱位次数1～6次,平均4次。患膝关节疼痛、肿胀及髌骨不稳,髌骨向外侧活动度明显增大,恐惧征阳性。X线片见髌骨脱位或内缘撕脱骨折,髌股对合角为(10±11)°,Q角为(15±3)°。根据Kujala等的髌股关节评分标准,总评分为(60.8±7.2)分。术中行内移胫骨结节术4例。采用同种异体肌腱双束解剖重建,髌骨止点用2枚锚钉固定,股骨止点用挤压螺钉固定。结果术后18例切口Ⅰ期愈合,2例Ⅱ期愈合;未发生感染及移植物坏死、吸收。患者术后均获随访,随访时间6～34个月,平均25.6个月。末次随访时1例蹲起时膝关节疼痛,其余患者无膝关节疼痛、肿胀及髌骨不稳;无复发髌骨脱位及髌骨骨折。术后6个月X线片示锚钉及隧道位置良好,髌股对合角为(3±8)°,与术前比较差异有统计学意义(P<0.05)。末次随访时Q角为(15±2)°,与术前比较差异无统计学意义(P>0.05);髌股关节总评分为(83.4±8.0)分,与术前比较差异有统计学意义(P<0.05)。按照Insall等标准评价髌股关节功能,优12例,良6例,中2例,优良率90%。结论同种异体肌腱双束解剖重建MPFL治疗髌骨脱位能恢复正常解剖,锚钉固定能减少骨量丢失及髌骨骨折发生,采用同种异体肌腱能避免患者的二次损伤。但术中需将金属锚钉留置体内,且异体移植物的应用增加了手术成本。
Objective To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament（MPFL）in patellar dislocations.Methods From September 2005 to June 2008,20 patients with patellar dislocation underwent MPFL reconstructions.There were 4 males and 16 females,aged 13 to 31 years（19 years on average）.Patellar dislocations occurred in 7 left and 13 right knees,including 6 cases of acute dislocation and 14 cases of recurrent dislocation.The disease course was 1 day to 2 years.The frequency of dislocation was 1-6（4 on average）.Affected knee joint showed pain,swelling and patellar instability;the range of action for patella obviously increased.The X-ray films showed patellar dislocation or medial margin avulsion fracture.The preoperative Q angle was（15±3）°,the congruence angle was（10±11）°.Reconstruction was performed via allograft tendon.Allograft tendon was anchored to the superomedial pole of the patella by two bone anchors,and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel.All patients were evaluated postoperatively;Kujala patellofemoral scores, objective knee function,complications,and reoperations were assessed.Results Primary healing was achieved in 18 cases and secondary healing in 2 cases.No infection or necrosis and absorption of grafts was observed.All patients were followed up for an average of 25.6 months（range,6-34 months）postoperatively.At last follow-up,other patients had no pain,swelling and patellar instability except 1 case;neither patella redislocation nor fracture occurred.The X-ray films showed good position of anchors and tunnel 6 months after operation,and the congruence angle was（3±8）°,showed statistically significant difference when compared with preoperation（P0.05）.The postoperative Q angle was（15±2）°,the Kujala knee function score improved significantly from 60.8±7.2 to 83.4±8.0 at last follow-up,showing
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第1期100-103,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
髌骨脱位
内侧髌股韧带
解剖重建
同种异体肌腱
关节镜
Patellar dislocation Medial patellofemoral ligament Anatomical reconstruction Allograft tendon Arthroscope
