自体半腱肌肌腱双束重建内侧髌股韧带治疗不伴有骨性畸形的复发性髌骨脱位

Treatment of recurrent patellar dislocation without bone deformity by autologous semitendinosus tendon and double bundles reconstruction of medial patellofemoral ligament

目的探讨自体半腱肌肌腱双束重建内侧髌股韧带(MPFL)治疗不伴有骨性畸形的复发性髌骨脱位的临床疗效。方法回顾性分析2015年6月-2017年12月芜湖市中医院采用自体半腱肌肌腱双束解剖重建MPFL的12例不伴有骨性畸形的复发性髌骨脱位患者的临床资料,其中男2例、女10例,年龄14~46(27.75±10.14)岁。所有患者术中髌骨侧采用2枚带线锚钉固定移植物,关节镜下调节张力后股骨侧采用界面挤压螺钉固定移植物。术后定期进行随访,主观评价髌股关节摩擦感、髌骨异常活动、髌骨外推试验及外推恐惧试验、膝关节活动度、肌力检测,影像学(X线片及CT)评估测量骨道位置,采用Lysholm、Tegner和Kujala主观评分评价手术前后膝关节功能。结果12例患者手术均顺利,术后随访12~24个月,平均13.5个月。术后均无髌骨再脱位、髌骨错动,0°位和屈膝30°位髌骨外推试验和外推恐惧试验均为阴性。Lysholm评分术前为(66.00±4.71)分、末次随访为(92.67±3.23)分,Tegner评分术前为(3.33±0.89)分、末次随访为(5.33±0.78)分,Kujala主观评分术前为(53.67±3.23)分、末次随访为(91.50±2.68)分,差异均有统计学意义(t=16.248、32.176、89.350,P值均<0.01)。结论对于不伴有骨性畸形的复发性髌骨脱位的患者,自体半腱肌肌腱双束解剖重建MPFL,是一种安全、有效、可靠的治疗方法,能够获得满意的临床效果。

Objective To evaluate the clinical efficacy of autologous semitendinosus tendon and double bundles reconstruction of medial patellofemoral ligament(MPFL) in the treatment of recurrent patellar dislocation without bone deformity. Methods The retrospective analysis was performed on the clinical data of 12 patients with recurrent patellar dislocation without bone deformities who were reconstructed by autologous semitendinosus tendon in Wuhu Hospital of Traditional Chinese Medicine from June 2015 to December 2017, including 2 males and 10 females, aged 14-46(27.75±10.14) years. All patients whose lateral patellar anchor nail fixed graft using two belt line, the femur after adjusting the tension side under arthroscopy using extrusion screw implant interface, postoperative 1, 3, 6 and 12 months follow-up, subjective evaluation of patellofemoral joint friction feeling, patellar abnormal activities, patellar extrapolation experiment and extrapolation of fear, the knee joint motion, muscle strength test. Imaging(X-ray) was used to evaluate the position of the bone tract, and Lysholm, Tegner and Kujala scores were used to evaluate the knee function before and after surgery. Results All 12 patients were successfully operated, and were followed up for 12 to 24 months, mean 13.5 months. No patella redislocation or patella dislocation were found after operation.0° and 30° bend knees a patellar extrapolation experiment and extraopolation fears were negative. The lysholm score was preoperative 66.00±4.71 and the final follow-up 92.67±3.23.Tegner score was preoperative 3.33±0.89 and the final follow-up 5.33±0.78.The subjective scores of Kujala were preoperative 53.67 ±3.23 and final follow-up 91.50±2.68, with statistically significant differences(t=16.248, 32.176, 89.350, all P values<0.01). Conclusions MPFL is a safe, effective and reliable method and can achieve satisfactory clinical result for the reconstruction of MPFL with autologous semitendinosus tendon and double beam anatomic reconstruction in patients with recurrent patrllar dislocation.