异体肌腱移植重建内侧髌股韧带髌骨端不同固定方法的疗效分析

Efficacy of Reconstruction of Medial Patellofemoral Ligament with Allogeneic Tendon Transplantation Using Different Fixation Methods

目的回顾性分析同种异体肌腱重建内侧髌股韧带髌骨端移植肌腱缝合锚固定和髌骨隧道固定的临床疗效差异。方法选取2010年7月至2011年7月我院收治的复发性髌骨脱位患者20例(20膝),均采用髌骨隧道固定肌腱;选取2011年7月至2012年7月的患者20例(20膝),均采用髌骨内侧缘开骨槽以缝合锚固定肌腱。术前、术后1年按照Kujala及Lysholm评分评价膝关节功能并测量术后适合角(CA)、外侧髌股角(LPA)及髌骨外移距离(LS)。结果所有患者均获得随访,术后平均随访11个月(1～15个月)。末次随访髌骨隧道固定肌腱和缝合锚固定肌腱术后Kujala评分分别为(86±4.2)分和(87±3.8)分;Lysholm评分分别为(46.2±3.63)分和(45.8±3.81)分,与术前相比评分明显提高,2种方法术后Kujala及Lysholm评分比较差异无统计学意义(P>0.05)。CA、LPA及LS在术后得到明显改善,2种方法的术后测量值差异无统计学意义(P>0.05)。结论髌骨端采用缝合锚固定肌腱与髌骨隧道固定肌腱手术效果相同。

Abstract Objective To estimate the differences of clinical effects between suture anchor fixation and patella bone tunnel fixation. Methods A retrospective analysis of reconstruction of medial patellofemoral ligament with allogeneie tendon unnsplantation for the treatment of patellar instability was performed, including 20 patients（ 20 knees ） of recurrent dislocation of the patella from July 2010 to July 2011 admitted in our hospital who underwent fixation using suture anchors and bone groove, and another 20 patients（20 knees ） from July 2011 to July 2012 who underwent frxation using patellar bone tunnels. The preoperative and postoperative 1 year of knee joint function was evaluated according to Kujala and Lysholm scoring form. Congruence angle （CA）, lateral patellofemoral angle （LPA）, and lateral shift （LS） was also measured. Results These patients were followed up for a average of 11 months after operation （ 1-15 months ）. The Kujala scores of patellar bone tunnel fixation and suture anchor fixation were （86±4.2） and（87±3.8） points respectively at the final follow-up;the Lysholm scores of the two methods were respectively （46.2±3.63） and（45.8±3.81 ） points, which were significantly increased compared with the preoperative score. No statistical significance of the postoperative Kujala and Lysholm scores was found between the two methods （P 〉 0.05 ）. Postoperative CA, LPA and LS were obviously imp^ved after surgery, and there was no statistically significant difference in the postoperative measurements between the two methods. Conclusion Fixing the tendon on the patella by suture anchor fixation or patellar bone tunnel fixation has the same chnical, effects.