重建与缝合修复内侧髌股韧带在治疗髌骨脱位中的临床研究

A clinical study on reconstruction and suture repair medial patellofemoral ligament in the treatment of patellar dislocation

目的 研究内侧髌股韧带的自体半腱肌腱等长重建与缝合修复两种手术技术治疗髌骨脱位临床疗效,为临床治疗提供参考.方法 选择40例髌骨脱位患者,采用缝合修复手术的20例为缝合组,采用韧带重建的20例为重建组,检测两组术后3,14d红细胞沉降率及C反应蛋白,观察比较两组手术前后适合角（CA）、外侧髌股角（LPA）、髌骨外移率（LS）,术后膝关节功能,临床疗效.结果 两组术前CA、LPA、LS比较差异无统计学意义（P＞0.05）;两组术后CA、LPA、LS均较术前明显改善[缝合组：（9.13±1.88）°比（16.50±2.83）°、（8.48±1.19）°比（-1.28±2.12）°、（0.52±0.43）°比（0.78±0.32）°;重建组：（6.69±1.83）°比（16.95±3.17）°、（6.24±1.33）°比（-0.91±2.00）°、（0.32±0.23）°比（0.70±0.16）°],差异有统计学意义（P＜0.01）;重建组术后CA、LPA、LS改善程度均优于缝合组,差异有统计学意义（P＜0.01）.缝合组Lysholm膝关节功能评分总分为（38.27±17.06）分,重建组为（79.44±9.86）分,两组比较差异有统计学意义（P＜0.05）.两组术后3,14d红细胞沉降率及C反应蛋白比较差异无统计学意义（P＞0.05）.结论 内侧髌股韧带的自体半腱肌腱等长重建治疗髌骨脱位的手术效果明显好于缝合修复,内侧髌股韧带重建可以有效地恢复髌股关节的对合关系,从根本上治愈髌骨脱位.但是重建手术创伤大,中、远期疗效还需要进一步研究探讨.

Objective To explore the operation effect of isometric reconstruction of the medial patellofemoral ligament with the semitendinosus tendon and direct suture rehabilitation of the medial patellofemoral ligament in the treatment of patellar dislocation,and provide some reference for the surgical treatment of this disease.Methods Forty patients with patellar dislocation included 20 patients with suture repair （suture group） and 20 patients with reconstruction （reconstruction group）.The erythrocyte sedimentation rate,C-reactive protein were determined at 3,14 d after operation in two groups.The congruence angles （CA）,lateal patellofemoral angle （LPA）,lateral patellar displacement（LS） before and after operation,knee joint function,efficacy after operation were observed and compared.Results There was no significant difference in CA,LPA,LS between two groups （P ＞ 0.05）.CA,LPA,LS after operation were improved compared with before operation in two groups [suture group：（9.13 ± 1.88）° vs.（16.50 ±2.83）°,（8.48 ± 1.19）° vs.（-1.28 ± 2.12）°,（0.52 ± 0.43）° vs.（0.78 ± 0.32）° ;reconstruction group：（6.69 ± 1.83）° vs.（16.95 ±3.17）°,（6.24 ± 1.33）° vs.（-0.91 ±2.00）°,（0.32 ±0.23）° vs.（0.70 ±0.16）°],and there was significant difference （P＜ 0.01）.The improvement of CA,LPA,LS in reconstruction group were better than that in suture group,and there was significant difference （P＜ 0.01）.The knee joint function score by Lysholm was （38.27 ± 17.06） scores in suture group,（79.44 ±9.86） scores in reconstruction group,and there was significant difference （P ＜ 0.05）.There was no significant difference in the erythrocyte sedimentation rate,C-reactive protein at 3,14 d after operation between two groups （P ＞0.05）.Conclusions The operation effect of isometric reconstruction of the medial patellofemoral ligament with the semitendinosus tendon method is better than the direct suture rehabilitation of the medial patellofemoral ligament method,the former can effectively restore the relationship between patella and femoral trochlea,and cure the dislocation of patella from the root.