胫骨结节内旋技术在治疗伴股骨滑车发育不良的复发性髌骨脱位中的作用

ROLE OF TIBIAL TUBERCLE INTERNAL ROTATION TO TREAT RECURRENT PATELLAR DISLOCATION ASSOCIATED WITH TROCHLEAR DYSPLASIA

目的探讨胫骨结节内旋技术在治疗伴股骨滑车发育不良的复发性髌骨脱位中的作用。方法 2007年2月-2011年4月,收治28例伴股骨滑车发育不良的复发性髌骨脱位患者。男4例,女24例;年龄17-28岁,平均21.8岁。病程6个月-8年,平均4年。脱位3-10次。患者恐惧试验阳性,Lysholm评分为（51.64±3.79）分,Kujala评分为（56.89±3.79）分。滑车发育不良根据Dejour分型标准：B型11例、C型14例、D型3例;胫骨结节-股骨滑车沟间距（tibial tuberosity-trocholear distance,TT-TG）值为（20.53±2.58）mm,髌骨倾斜角（patellar tilt angle,PTA）为（29.34±2.54）°。术中采用改良Fulkerson方法行胫骨结节截骨,并通过内移、内旋、抬高技术调整髌股关系,联合自体半腱肌腱解剖重建内侧髌股韧带。结果术后除1例切口轻度感染外,其余切口均Ⅰ期愈合。27例患者获随访,随访时间27-74个月,平均41.8个月。术后患者均无髌骨再脱位,恐惧试验阴性。膝关节屈伸活动度均恢复正常。末次随访时,Kujala评分为（88.97±3.06）分,Lysholm评分为（88.95±2.98）分,均较术前显著提高（t=—42.005,P=0.000;t=—43.122,P=0.000）。末次随访时TT-TG值、PTA均恢复至正常范围,分别为（11.77±2.24）mm以及（7.99±2.57）°,与术前比较差异均有统计学意义（t=13.032,P=0.000;t=29.533,P=0.000）。结论对于伴股骨滑车发育不良的复发性髌骨脱位,采用胫骨结节移位联合内侧髌股韧带重建治疗可以恢复髌骨稳定性,改善膝关节功能,临床疗效较好。尤其通过胫骨结节内旋技术可有效改善髌股关节对合关系和髌骨运动轨迹,增加髌股关节匹配。

Objective To introduce and analyze the role of tibial tubercle internal rotation to treat recurrent patellar dislocation associated with trochlear dysplasia. Methods Between February 2007 and April 2011,28 patients with recurrent patellar dislocation underwent tibial tubercle translocation through medial transfer,rotation and elevation of the tibial tuberosity and the medial patellofemoral ligament（MPFL） reconstruction. There were 4 males and 24 females with an average age of 21.8 years（range,17-28 years）. The disease duration ranged from 6 months to 8 years（mean,4 years）. The patients suffered from 3-10 times patellar dislocation. The result of apprehension test was positive; Lysholm score was（51.64±3.79）; Kujala score was（56.89±3.79）. According to Dejour classification,11 cases were rated as type B,14 cases as type C,and 3 cases as type D; the tibial tuberosity-trocholear distance（TT-TG） was（20.53±2.58） mm; and the patellar tilt angle（PTA） was（29.34±2.54）°. Results Primary healing of incision was obtained in the others except 1 case of mild infection. Twenty-seven patients were followed up 41.8 months on average（range,27-74 months）. No recurrent dislocation was found,and the result of apprehension test was negative. The knee range of motion restored to normal totally. The postoperative Kujala score and Lysholm score were significantly improved to 88.97±3.06 and 88.95±2.98（t= —42.005,P=0.000; t= —43.122,P=0.000） respectively. TT-TG and PTA restored to normal [（11.77±2.24） mm and（7.99±2.57）°],showing significant differences when compared with preoperative ones（t=13.032,P=0.000; t=29.533,P=0.000）. Conclusion The technique of tibial tubercle translocation and MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation associated with trochlear dysplasia. Especially,tibial tubercle internal rotation can improve the patella stability and knee function.