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两种股骨隧道定位法内侧髌股韧带重建术比较 被引量:9

Comparison of two localization technique of femoral tunnel in medial patellofemoral ligament reconstruction
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摘要 [目的]比较内侧髌股韧带(MPFL)重建术中,采取徒手触摸骨性标志(触摸组)和C臂透视(透视组)两种股骨隧道定位方式的临床结果。[方法]回顾本科室在2013年1月~2016年1月期间52例行MPFL重建术患者。其中,26例采用取术中触摸股骨内上髁定位,26例采用术前特殊导向器透视下标记定位。比较两组手术时间、切口长度、Lysholm评分。行CT三维重建检查,按照Sch?ttle等的方法测定股骨隧道位置。[结果]两组患者均顺利手术,无严重并发症。触摸组手术时间显著长于透视组(P<0.05);触摸组切口长度显著长于透视组(P<0.05)。本组52例患者随访(14.13±2.04)个月。所有患者随访中均未出现"打软腿"和"交锁"等髌骨半脱位或脱位症状,髌骨外推试验均阴性。术前两组间Lysholm评分的差异无统计学意义(P>0.05);末次随访时两组患者Lysholm评分均较术前显著增加,差异有统计学意义(P<0.05);末次随访透视组的Lysholm评分显著高于触摸组,差异有统计学意义(P<0.05)。触摸组中11例为等距隧道,15例为非等距隧道,而透视组中所有患者均为等距隧道。[结论]两种定位方法 MPFL重建治疗复发性髌骨脱位均可取得满意的临床效果,相比之下,C臂透视股骨定位优于徒手触摸定位。 [Objective] To compare the clinical outcomes of two methods for femoral tunnel localization, the hand-feeling versus fluoroscopy with a special guider, in medial patellofemoral ligament(MPFL) reconstruction.[Methods] A retrospective study was conducted on 52 patients who underwent MPFL reconstruction for recurrent patellar dislocation or instability between January 2013 and January 2016. Of them, 26 patients had the femoral insertion localized by hand feeling the medial femoral epicondyle intraoperatively(the HF group), while the remaining 26 patients had the point localized by marks on the skin using a special guider under fluoroscopy just before operation(the FL group). The operation time, incision length, Lysholm score and deviations to the isometric point measured on 3-D CT scanning were compared between the two groups.[Results] All the patients had surgical procedure performed smoothly without serious complication. The HF group consumed significantly longer operation time, associated with more lengthy incision than the FL group(P<0.05). The patients were followed up for(14.13±2.04) months on average. During the period of follow up, no symptoms of patellar subluxation or instability, such as "giving way" and"locking" happened in anyone of them, whereas the sign of patella pushed laterally was negative in all the patients. Although the Lysholm scores proved of no a statistically significant difference between the two groups preoperatively(P>0.05), which significantly increased in both groups at the latest follow up compared with those before operation(P<0.05), the HF group proved of significantly lower Lysholm score than the FL group at the latest follow up(P<0.05). In term of isometric point measured radiographically, the HF had isometric femoral insertion in 11 patients and non-isometric insertion created in 15 patients, by contrast, the FL group had isometric insertion made in all the 26 patients.[Conclusion] Satisfactory clinical outcomes are achieved by both hand feeling and fluoroscopy localization of f
作者 雷鸣鸣 华强 LEI Ming-ming;HUA Qiang(Department of Orthopaedics, Sports Medicine and Arthroscopy, The Sports Hospital, Chengdu Sport University, Chengdu610041, China)
出处 《中国矫形外科杂志》 CAS CSCD 北大核心 2019年第16期1461-1466,共6页 Orthopedic Journal of China
基金 四川省中医药管理局科学技术研究专项项目(编号:2018JC002)
关键词 髌股关节不稳 内侧髌股韧带 定位方法 股骨隧道 等距点 patellofemoral instability medial patellofemoral ligament positioning method femoral tunnel isometric point
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