锚钉缝线减张重建内侧髌股韧带髌骨止点治疗复发性髌骨脱位

Reconstructed technique of medial patellofemoral ligament fixed on patella by bone anchor and suture for treatment of recurrent patellar dislocation

目的探讨锚钉缝线减张重建内侧髌股韧带(MPFL)髌骨止点的技术及其治疗复发性髌骨脱位的效果。方法回顾性分析自2009-03—2013-03采用锚钉缝线减张缝合法重建MPFL髌骨止点治疗复发性髌骨脱位21例,其中17例非固定型髌骨脱位,4例固定型脱位。采用自体肌腱双束重建,髌骨止点用缝线固定并锚钉加强。比较术前及术后1 d、6周、1年于膝关节0°位CT测量髌骨倾斜角、髌股关节匹配角、锚钉尖距髌骨外缘距离,术前及术后1年Kujala评分。结果本组均获得12个月以上随访,术后2例髌骨再脱位,2例屈膝受限,17例膝关节活动正常、无髌骨不稳。19例术后1年髌骨倾斜角、髌股关节匹配角较术前明显减小,差异有统计学意义(P<0.05);术后1 d、6周、1年髌骨倾斜角、髌股关节匹配角、锚钉尖距髌骨外缘距离差异无统计学意义(P>0.05)。非固定型脱位17例术后1年Kujala评分(85.8±3.4)分,较术前(54.1±5.6)分明显提高,差异有统计学意义(P<0.05)。结论关节镜下缝线结合锚钉内固定重建的MPFL髌骨止点治疗复发性髌骨脱位能够明显改善髌骨稳定性。

Objective To investigate the surgical reconstructed technique of medial patellofemoral ligament（MPFL）’s inserted points on patella and discuss this reconstruction operation’s efficacy of the recurrent patellar dislocation. Methods A retrospective analysis of clinical cases of recurrent patellar dislocation was based on 21 patients who underwent reconstruction operation of MPFL’s inserted points on patella between March 2009 and March 2013. Seventeen of 21 patients suffered from patellar subluxation, and 4 of 21 patients suffered from persistent patellar dislocation. The double autograft tendons were used to reconstruct MPFL. Reconstruction of MPFL’s double inserted points on patella was that double autograft tendons were fixed on the medial edge of patella by suture combined with inserting bone anchor into patella. At 1 day, 6 weeks and 1 year after operation, CT scan of straight knee at 0° position was performed, to measure patellar tilt angle, congruence angle and length between bone anchor and lateral edge of patella, the CT data were compared with thoese before operation. Kujala score was counted at 1 year after operation, which was compared with scores before operation. Results All the patients were followed up for above 12 months. After operation, 2 patients suffered from re-dislocation, 2 patients had stiff knees on flexion, 17 patients had normal range of knee motion and did not experience patella instability. In 19 patients, the patellar tilt angle or congruence angle, which was reduced at 1 year after their operation, showed significant differences compared with those before their operation（P 〈0.05）. In patellar tilt angle, congruence angle or length between bone anchor and lateral edge of patella,among three groups of data which were collected at 1 day after 19 patients’ operation, 6 weeks and 1 year of their follow-up,there were no significant differences（P 〉0.05）. In 17 patients with patellar subluxation, Kujala score（85.8 ±3.4） was counted at 1 year after follow up, it was higher than score（54.1 ±5.6） before operation, between two groups of Kujala score there were significant differences（P 〈0.05）. Conclusion Arthroscopic reconstructed technique of MPFL’s inserted points on patella by suture combine with bone anchor of internal-fixation in patella, could improve the patella stability in treatment of recurrent patellar dislocation.