部分腓骨长肌腱重建内侧髌股韧带治疗复发性髌骨脱位

Treatment of recurrent patellar dislocation via medial patellofemoral ligament reconstruction with partial peroneus Iongus tendon

目的探讨关节镜辅助下自体部分腓骨长肌腱移植重建内侧髌股韧带（medialpatellofemoralligament，MPFL）治疗复发性髌骨脱位的疗效。方法2009年5月-2010年4月治疗46例53膝复发性髌骨脱位患者，关节镜下进行外侧髌股支持带松解后，采用自体部分腓骨长肌腱游离移植重建MPFL，调整移植肌腱在不同角度下屈伸活动时的张力，关节镜下观察髌骨运动轨迹和股骨滑车与髌骨的对应关系，然后采用可吸收界面螺钉将肌腱端固定于股骨内侧髁的骨道内，同时行胫骨结节内移抬高术。了解髌股关节的稳定情况、脱位复发、患膝主观症状以及患肢整体功能康复情况。结果术后随访平均18个月（12～24个月），膝关节稳定性增加，髌骨脱位无复发。恐惧试验阴性，髌骨轴位x线片和CT示髌股关节解剖关系恢复正常。手术前后Kujala髌骨稳定度问卷评分术前（54．6±5．4）分，术后（92．3±8．9）分（t=55．41，P〈0．01）。所有患者运动能力均较术前有所改善。术后CT检查对比发现，髌骨与股骨滑车适配角从术前的（27．8±8．1）°改善为（2．3±9．4）°（t=20．87，P〈0．01）。肌腱供区踝关节活动良好，功能没有影响。结论关节镜下外侧髌股支持带松解与自体部分腓骨长肌腱移植重建MPFL，结合胫骨结节内移抬高术能够有效治疗复发性髌骨脱位，并且避免了膝关节周围切取肌腱的潜在并发症。

Objective To investigate effects of arthroscopic reconstruction of medial patellofemoral ligament （MPFL） using partial peroneus longus tendon autograft in treating recurrent patellar dislocation . Methods Forty-six patients （53 knees ） with recurrent dislocation of patella received autologous partial peroneus longus tendon grafting for MPFL reconstruction after arthroscopic lateral retinaculum release from May 2009 to April 2010. Anatomic relation between femoral trochlea and patella, and motion path of patella were observed arthroscopically in adjustment of flexion and extension strength of grafted tendon in different angles. Successively, the tendon ends were fixed within bone tunnel of medial femoral condyle by using absorbable interface screws with synchronous superomedial displacement of tibial tuberosity. Stability of patellofemoral joint, dislocation recurrence, subjective symptoms of affected knees and general function recovery condition of affected limbs were studied. Results All patients were followed up for average 18 months （range, 12-24 months）, which showed the improvement of knee joint stability, without recurrence of patellar dislocation. Apprehensive test was negative. Axial X-ray films and CT of patella showed normal anatomical relation of patellofemoral joint. The Kujala patellar stability questionnaire scored （54.6 ±5.4） points before operation and （92.3±8.9） points after operation （t = 55.41, P 〈 0. 01 ）. All patients showed some improvement of motor ability after operation. CT examination showed that the congruence angle of patella and femoral trochlea was improved from preoperative （ 27.8 ± 8. t ） ° to postoperative （2.3± 9.4） °（ t = 20.87, P 〈 0. 01 ）. Otherwise, ankle joint in the tendon donor site acted well, with normal function. Conclusion Arthroseopic lateral patellar retinaculum release and MPFL reconstruction using partialperoneus longustendon autograft are effective in treatment superomedial displacement of tibial tuberosity, around knee joint. of recurrent patellar dislocation in combination with and avoid potential complications in tendon removal from.