带袢钛板单骨道重建与骨槽带线锚钉双束重建内侧髌股韧带治疗复发性髌骨脱位的疗效比较

Efficacy comparison between single canal reconstruction with belt loops titanium plate and double bundle reconstruction of medial patellofemoral ligament for recurrent patellar dislocation

背景:髌骨不稳定的疾病逐渐得到重视,而治疗髌股关节不稳定的方法很多,需要探讨一个安全、有效、副作用小的手术方式。目的:探讨带袢钛板单骨道重建与骨槽带线锚钉双束重建内侧髌股韧带治疗复发性髌骨脱位的疗效比较。方法:回顾性分析2014年12月至2016年12月收治的复发性髌骨脱位患者69例,均为单膝,其中对照组采用带袢钛板单骨道重建,共33例,男7例,女26例,年龄15～30岁,平均(18.5±3.5)岁;试验组采用骨槽带线锚钉双束重建,共36例,男8例,女28例,年龄15～30岁,平均(17.9±4.3)岁。患者术前症状主要包括行走摔倒、关节不稳、髌骨多次脱位病史,查体示髌骨恐惧试验(+)。测量术前和术后的外侧髌股角、髌骨倾斜角,采用术前和术后行Kujala主观评分、Lysholm评分来评估膝关节功能。结果:所有患者均获得随访,随访时间为12～36个月,平均(24.0±2.1)个月,切口均愈合良好,活动无受限,查体示髌骨恐惧试验(-),患者均较满意,对照组和试验组的末次随访Kujala主观评分分别为(83.6±3.3)分和(87.2±2.9)分,与术前比较差异有统计学差异(P<0.01),组间比较无明显统计学意义(P>0.05);末次随访Lysholm评分分别为(89.5±2.9)分和(90.0±8.9)分,与术前比较差异有统计学意义(P<0.01),组间比较无明显统计学差异(P>0.05)。结论:带袢钛板单骨道重建与骨槽带线锚钉双束重建内侧髌股韧带治疗复发性髌骨脱位均可有效改善髌股关节不稳的状态,短期内可获得良好的临床效果。

Background: Patellar instability is gaining increasing attention, and there are many methods to treat thepatellofemoral joint instability. It is essential to explore a safe, effective and less side effect operation. Objective:To comparethe therapeutic effect of single canal reconstruction with belt loops titanium plate and double bundle reconstruction of medialpatellofemoral ligament for recurrent patellar dislocation. Methods:A retrospective analysis was performed in 69 patients withunilateral recurrent patellar dislocation treated from December 2014 to December 2016 in our hospital. Single loop of titaniumplate bone reconstruction was used in 33 patients(control group, 7 males and 26 females with a mean age of[18.5±3.5]yearsold, ranging from 15 to 30 years old). Bone anchor slot double bundle reconstruction was applied in 36 patients(experimentalgroup, 8 males and 28 females with a mean age of[17.9±4.3]years old, ranging from 15 to 30 years old). Main preoperativesymptoms and sign included falling while walking, joint instability, repeated patellar dislocation, and positive patellarapprehension sign. Preoperative and postoperative lateral patellofemoral angle and patellar tilt angle were measured. Kujalasubjective score and Lysholm score were used to evaluate the function of knee joint. Results:All the patients were followedup, and the mean duration of follow-up was(24.0±2.1)months(range, 12-36 months). The incision healed well and nomovement limitation was found. The results of patellar apprehension test became negative and the patients were satisfied. Atthe final follow-up, Kujala subjective score were 83.6±3.3 in the control group and 87.2±2.9 in the experimental group, whichwere significantly higher than preoperative ones(P<0.01). Lysholm score were 89.5±2.9 and 90.0±8.9 in the control andexperimental groups, which were also significantly higher than preoperative ones(P<0.01). But there were no significantdifferences in the Kujala subjective score or Lysholm score between the two groups(P >0.05). Conclusions:Bothreconstruction with unilateral titanium plate and double bundle reconstruction of medial patellofemoral ligament with titaniumplate can effectively improve patellofemoral instability and achieve good clinical results in short term.