重建内侧髌股韧带治疗复发性髌骨脱位

Reconstruciton of medial patellofemoral ligament(MPFL) for the treatment of recurrent patellar dislocation

目的:探讨重建内侧髌股韧带治疗复发性髌骨脱位的中期效果。方法:2007年2月至2010年1月,复发性髌骨脱位65例,男6例,女59例;年龄17～24岁,平均20岁;右膝35例,左膝30例。全部取自体同侧半腱肌重建内侧髌股韧带。手术前后采用Lysholm及Tegner进行功能评分,影像学采用Congruence角及Sulcus角评分。结果:全部病例获随访,时间15～23个月,平均20个月,无膝关节髌骨半脱位或脱位。Lysholm膝关节功能评分从术前的(60.6±3.7)分升至(89.8±4.6)分(t=-15.58,P=0.00);IKDC评分从术前的平均(40.0±3.5)分升至(82.0±3.6)分(t=-27.44,P=0.00);Tegner评分从术前的平均(3.6±0.4)分升至(5.6±0.3)(t=-10.84,P=0.00);Congruence角由术前的平均(26.4±3.9)°降至(4.3±1.8)°(t=16.15,P=0.00);Sulcus角由术前的平均(148.8±2.0)°降至术后的(140.5±1.6)°(t=10.51,P=0.00)。结论:重建内侧髌股韧带治疗复发性髌骨脱位能提供足够的张力,维持髌骨稳定性。

Objective：To evaluate the middle term effectiveness of medial patellofemoral ligament （MPFL） reconstruction for the treatment of recurrent patellar dislocation. Methods：From February 2007 to January 2010,65 patients including 6 males and 59 females with recurrent patellar dislocation received the MPFL reconstruction. The reconstruction was performed using ipsilateral semitendinosis tendon to restore the damaged MPFL. Patients were evaluated pre-operatively and post-operatively by physical and subjectively with the IKDC （International Knee Documentation Committee）,Tegner,and Lysholm questionnaires and radiographic examination. Results：The average follow-up duration was 20 months（ranged,15 to 23 months）. No recurrent episodes of dislocation or subluxation occurred. A firm endpoint to lateral patellar translation was noted in all patients at most recent follow-up. The Lysholm subjective knee evaluation score improved from（60.6±3.7）preoperatively to（89.8±4.6）postoperatively; and Tegner scores improved from（3.6±0.4）to（5.6±0.3）,IKDC from（40.0±3.5）to（82.0±3.6）. Radiographic evaluation demonstrated improvements in the congruence and sulcus femoral angles. Conclusion：MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation.