内侧髌股韧带重建联合胫骨结节移位和关节镜下外侧支持带松解术治疗持久性髌骨脱位

Medial patellofemoral ligament reconstruction combined with both tibial tubercle transfer and arthroscopic lateral retinaculum release in treatment of persistent disloation of patella

目的观察内侧髌股韧带重建联合胫骨结节移位和关节镜下外侧支持带松解术治疗持久性髌骨脱位的效果。方法对6例持久性髌骨脱位患者的10个膝关节行内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术。手术前后采用Lysholm膝关节功能评价表和Kujala评分表进行评估,并通过CT观测手术前后髌骨外移度。结果 6例均获随访,时间24～36(29±7.21)个月。Lysholm评分术前为47.10分±10.31分,术后24个月为83.11分±5.21分,差异有统计学意义(P<0.05);Kujala评分术前为41.26分±13.36分,术后24个月为82.33分±5.31分,差异有统计学意义(P<0.05)。患膝运动能力均较术前明显改善。髌骨外移度术前为35.61 mm±5.37 mm,术后为4.30mm±1.13mm,差异有统计学意义(P<0.05)。结论内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术能够有效纠正持久性髌骨外侧脱位,缓解症状,恢复膝关节功能。

Objective To observe the effect of medial patellofemoral ligament reconstruction combined with both tibial tubercle transfer and arthroscopic lateral patella retinaculum release on patients with persistent disloation of patella. Methods 6 patients＇ 10 knee joint with persistent disloation of patella were treated with medial patellofemoral ligament reconstruction combined with both tibial tubercle transfer and arthroscopie lateral patellar retinaculum release. The patients were followed up and evaluated with Lyscholm and Kujala score. Using computed tomography scans of the patellofemoral joint to measure the lateral patellar displacement（LPD） before and after operation. Results All 6 patients were followed up range from 24 to 36 （ mean 29 ± 7. 21 ） months. The Lysholm knee score were 47. 10 ± 10. 31 preoperatively and 83.11 ± 5.21 twenty-four months postoperatively （ P 〈 0. 05 ） . The Kujala score were 41.26 ± 13.36 preoperatively and 82. 33 ± 5.31 twenty-four months postoperatively （P 〈 0. 05 ）. The sport ability improved obviously in all cases. The lateral patellar displacement（LPD） were 35. 61 mm ± 5. 37 mm preoperatively and 4. 30 mm ± 1.13 mm twenty-four months postoperatively （ P 〈 0. 05 ）. Conclusions The persistent disloation of patella can be effective corrected by medial patellofemoral ligament reconstruction combined with both tibial tubercle transfer and arthroseopic lateral patella retinaculum release . It can alleviate pain and restore knee function.