游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带治疗复发性髌骨脱位

Strengthening of the patellofemoral ligament by rivet fixation of the dissociative semitendinosus tendon for recurrent patellar dislocation

目的 探讨游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带治疗复发性髌骨脱位的疗效.方法 1999年3月至2008年1月共收治57例复发性髌骨脱位患者,男19例,女38例;年龄17～29岁,平均24.3岁;首次脱位至手术时间为1～4年,平均2.6年.行髌内侧支持带和髌股韧带修补手术15例（A组）,经髌骨骨隧道自体游离半腱肌腱重建内侧髌股韧带19例（B组）,自体游离半腱肌腱髌旁锚钉固定加强膝内侧髌股韧带23例（C组）.术后12个月按照Insall标准和Lysholm评分评价结果,并比较3种术式的疗效.结果 所有患者术后获12～37个月（平均18个月）随访.术前与术后12个月Lysholm评分A组平均分别为（80.3±2.9）、（89.6±3.7）分,B组平均分别为（80.9±3.1）、（94.6±3.4）分,C组平均分别为（81.2±3.9）、（93.6±4.1）分,3组患者术前与术后12个月Lysholm评分比较差异均有统计学意义（P〉0.05）.3组患者之间术前Lysholm评分比较差异无统计学意义（P〉0.05）;术后12个月B组与C组Lysholm评分差异无统计学意义（P〉0.05）,但均优于A组,差异有统计学意义（P〈0.05）.3组患者疗效按Insall标准评定：优良率分别为80.0%、94.7%、95.6%,3组间差异无统计学意义（P〉0.05）.结论 锚钉固定技术加强膝内侧髌股韧带的方式具有手术方式简单、损伤小、髌骨稳定性好、并发症少等优点,是治疗复发性髌骨脱位的一种良好选择.

Objective To investigate therapeutic effects of rivet fixation of the dissociative semitendinosus tendon to strengthen the patellofemoral ligament for management of recurrent patellar dislocations.Methods From March 1999 to January 2008, 57 cases of recurrent patellar dislocation were treated in our department. They were 19 males and 38 females, with an average age of 24. 3 （range, 17 to 29） years.Their disease courses ranged from 1 to 4 years （average, 2.6 years） . Of them, 15 （group A） were treated with repair of the medial retinaculum and patellofemoral ligament, 19 （group B） with reconstruction of the medial patellofemoral ligament, and 23 （group C） with rivet fixation of the dissociative semitendinosus tendon to strengthen the patellofemoral ligament. All the patients were followed up in the out-patient department 12months later. Functional recovery was evaluated by the Lysholm scores and the Insall evaluation. Results There were statistical significant differences between the preoperative and postoperative Lysholm scores in the 3 groups respectively. Group C had a comparable therapeutic effect with group B（ P 〉 0. 05） . The postoperative Lysholm score for group C was significantly higher than that for group A （ P 〈 0.05 ） . By the lnsall evaluation, the final percentages of superior results were 80. 0%, 94. 7% and 95.6% for groups A, B and C respectively（ P 〉 0. 05 ） . Conclusion For recurrent patella dislocations, rivet fixation of the dissociative semitendinosus tendon to strengthen the patellofemoral ligament can be as effective as the traditional medial patellofemoral reconstruction, but it is simpler and less invasive and may reduce the risk of patellar fracture.