关节镜辅助下小切口重建内侧髌股韧带治疗创伤性复发性髌骨脱位

Treatment of traumatic recurrent patellar dislocation through arthroscopic reconstruction of medial patellofemoral ligament

目的探讨关节镜辅助下小切口同种异体肌腱重建内侧髌股韧带(MPFL)治疗创伤性复发性髌骨脱位的临床效果。方法回顾性分析自2006年1月～2010年4月共收治28例创伤性复发性髌骨脱位,所有患者在第一次脱位均为膝关节外伤所致,伤后患膝明显肿胀及髌骨脱位-复位感,此后出现髌骨脱位3次以上者。手术方法:先行关节镜检查,髌骨外侧支持带紧张者行松解术,关节镜监视下调整MFPL的张力并于其解剖止点以同种异体肌腱重建MFPL,术后接受正规功能康复锻炼。结果术后平均随访26个月(12～36个月)。重建术后无髌骨再次脱位发生,髌股关节稳定。术前、术后均采用Lysholm和Kujala膝关节评分标准,手术前后评分差异有统计学意义(P<0.05)。结论选择适当的病例,重建内侧髌股韧带是治疗创伤性复发性髌骨脱位的有效方法。

Objective To explore the effectiveness of arthroscopic of the medial patellofemoral ligament reconstruction using the honmogeneous foreign body tendon for traumatic recurrent patellar dislocation.Methods Twenty eight cases of traumatic recurrent patellar dislocation were retrospectively analyzed from Jan.2006 to Apr.2010.All patients had injury history of the first patellar dislocation and experienced patellar dislocation more than 3 times.The surgical approach： the arthroscopic examination was undertaken before reconstructing medial patellofemoral ligament.The lateral retinaculum was released by arthroscopy if it was significant taut.The medial patellofemoral ligament was adjusted for its tension and reconstructed in anatomic insertion with honmogeneous foreign body tendon under arthroscope.All cases accepted regular rehabilitation.Results All patients were followed up with an average of 26 months（12~36 months）.The patellar stability was restored in all cases,and no recurrence of patellar dislocation was found within follow-up.Lysholm and Kujala scores were used preoperatively and postoperatively.Statistically,the difference between the two scores was significant（P0.05）.Conclusion It is an effective method that the medial patellofemoral ligament reconstruction is performed by using the honmogeneous foreign body tendon for traumatic recurrent patellar dislocation.