摘要
目的探讨关节镜下滑膜下髌骨外侧支持带松解联合自体半腱肌肌腱重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗髌骨脱位的疗效。方法 2016年1月—2017年3月,收治28例(32膝)髌骨脱位患者。男6例(6膝),女22例(26膝);年龄17~29岁,平均21岁。病程2 d^2年,平均8个月。患者髌骨恐惧试验阳性,膝关节Lysholm评分为(68.34±12.26)分。膝关节正位X线片显示髌骨半脱位或完全脱位,髌骨Q角(17.67±4.21)°,胫骨结节股骨滑车沟(tibia tuberosity-trochlear groove,TT-TG)距离<20 mm。采用关节镜下滑膜下髌骨外侧支持带松解联合MPFL重建术,MPFL股骨止点分别行骨隧道可吸收加压螺钉(16膝)或锚钉(16膝)内固定。结果术后切口均Ⅰ期愈合。患者均获随访6个月,患者膝关节功能较术前明显改善。术后6个月,膝关节Lysholm评分为(92.88±6.42)分,髌骨Q角为(12.15±3.68)°,与术前比较差异均有统计学意义(t=–3.408,P=0.006;t=–2.317,P=0.004)。髌骨恐惧试验均为阴性,随访期间无膝关节疼痛、无力及髌骨脱位复发。锚钉组及加压螺钉组Lysholm评分、髌骨Q角比较,差异均无统计学意义(t=–3.254,P=0.820;t=–3.576,P=0.940)。结论对于髌骨Q角<20°、TT-TG<20 mm的髌骨脱位患者,关节镜下滑膜下髌骨外侧支持带松解联合MPFL重建术,能明显改善膝关节功能,早期疗效较好。MPFL股骨止点采用锚钉或骨隧道可吸加压螺钉内固定,术后膝关节功能恢复无明显差异。
Objective To investigate the effectiveness of the arthroscopic lateral retinacular release combined with medial patellofemoral ligament （MPFL） reconstruction for patellar dislocation. Methods Between January 2016 and March 2017, 28 cases （32 knees） with patellar dislocation were treated by arthroscopic lateral retinacular release and MPFL reconstruction. There were 6 males （6 knees） and 22 females （26 knees） with an average age of 21 years （range, 17- 29 years）. The disease duration ranged from 2 days to 2 years （mean, 8 months）. Apprehension test of all patients were positive. The preoperative Lysholm score was 68.34±12.26. Anteroposterior X-ray film showed the patellar subluxation or dislocation. The Q angle was （17.67±4.21）° and the distance of tibia tuberosity-trochlear groove was less than 20 mm. The femoral attachment of retinacular were fixed by the interference screws （16 knee） or the anchors （16 knee）, respectively. Results All incisions healed by first intention. All patients were followed up 6 months. The function of knee joint was significantly improved at 6 months after operation. The Lysholm score was 92.88±6.42 and the Q angle was （12.15±3.68）° at 6 months. There were significant differences in the Lysholm score and the Q angle between pre- and post- operation （t=-3.408, P=0.006; t=-2.317, P=0.004）. Apprehension test of all patients were negative. No knee pain, knee weakness, and patellar dislocation occurred during follow-up. There was no significant difference in the Lysholm score and the Q Angle between the anchor group and interference screw group （t=-3.254, P=0.820; t=-3.576, P=0.940）.Conclusion Lateral retinacular release combined with MPFL reconstruction under arthroscopy can effectively improve the function of the knee joint for patients with Q angle less than 20° and TT-TG less than 20 mm, and the early effectiveness is good. There is no significant difference in knee function between the anchor and interference screw internal fixation
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第2期169-173,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
髌骨脱位
关节镜
外侧支持带松解
内侧髌股韧带
重建
Patellar dislocation
arthroscopy
lateral retinacular release
medial patellofemoral ligament
reconstruction
