关节镜指导下锚钉固定自体游离股薄肌腱加强内侧髌股韧带治疗髌骨不稳定

Strengthening of the Patellofemoral Ligament by Rivet Fixation of the Dissociative Gracilis Tendonfor Patellar Instability Guided by Arthroscopy

目的：探讨关节镜指导下锚钉固定自体游离股薄肌腱加强内侧髌股韧带治疗髌骨不稳定的手术方法和临床疗效。方法：1997年5月~2010年10月经临床和关节镜诊断的髌骨不稳定患者46例（49膝）,A组在行膝关节支持带外侧松解、内侧紧缩的基础上,配合胫骨结节内移的综合术式治疗;B组在行膝关节支持带外侧松解基础上,配合锚钉固定自体游离股薄肌腱加强内侧髌股韧带的综合术式治疗。结果：随访15~87个月（平均39个月）,A组优良率93.3%;B组优良率92.3%。按照Lysholm法评估膝关节功能,两组术后平均得分与术前比较均有显著性差异（P〈0.001）。结论：关节镜指导下锚钉固定自体游离股薄肌腱加强内侧髌股韧带治疗髌骨不稳定可恢复髌股关节稳定性,手术方式简单、创伤小、效果好,是治疗髌骨不稳定的理想方法。

Objective：To investigate therapeutic effects of rivet fixation of the dissociative gracilis tendon to strengthen the patellofemoral ligament for management of patellar instability.Methods：From May 1997 to October 2010, 46 cases （49 knees） with patellar instability 32 cases （group A）were treated with anterior tranfer of the gracilis or medial transfer of the tibial tuberosity, 15 cases （group B）with rivet fixation of the dissociative gracilis tendon to strengthen the patellofemoral ligament, both based on the lateral retinacular release and medial tightening. Results：The mean follow-up time was 39 months （15~87 months）. The excellent and good rates were 93.3%,92.3% respectively.Therewere statistical significant differences between the preoperative and postoperative Lysholm score in both groups.Conclusion：Rivet fixation of the dissociative gracilis tendon to strengthen the patellofemoral ligament for management of patellar instability can be as effective as the traditional surgical methods,and it is simpler and less invasive.