关节镜下自体半腱肌腱重建内侧髌股韧带联合Fulkerson截骨治疗复发性髌骨脱位

Arthroscopic reconstruction medial patellofemoral ligament with autogenous semitendinosus tendon combined with fulkerson osteotomy for recurrent patellar dislocation

目的探讨联合应用关节镜下自体半腱肌腱重建内侧髌股韧带术联合Fulkerson截骨治疗复发性髌骨脱位的效果。方法对18例复发性髌骨脱位的患者在关节镜下进行髌股外侧支持带松解术和自体半腱肌腱重建内侧髌股韧带,同时进行Fulkerson胫骨结节截骨内移抬高术。术后随访了解膝关节脱位复发、患膝主观症状以及患肢整体功能康复情况。结果所有患者术后均获得满意随访,随访时间6～24个月,平均随访时间12.7个月。髌骨脱位无复发。术后X线检查对比发现,髌骨-股骨滑车适配角从术前（25.8±6.9）°改善为（1.5±7.1）°（P〈0.01）,髌骨外侧面张开角从术前的（-1.3±6.2）°改善为术后的（12.8±3.9）°（P〈0.01）。膝关节术后1年时的Lysholm评分为（94.7±3.1）分,明显高于术前的（65.6±4.6）分（P〈0.05）;术后1年Kujala评分为（91.6±3.1）分,也明显高于术前的（60.3±3.3）分（P〈0.05）。术后1年根据Insall膝关节功能评分标准,其中优13膝,良4膝,可1膝,优良率达94.4%。结论关节镜下进行髌骨外侧支持带松解术和自体半腱肌腱重建内侧髌股韧带,结合Fulkerson胫骨结节截骨内移抬高术能够有效治疗复发性髌骨脱位,防止复发,并有利于缓解症状,恢复膝关节功能。

【Objective】To investigate the effect of arthroscopic reconstruction medial patellofemoral ligament with autogenous semitendinosus tendon combined with Fulkerson osteotomy for recurrent patellar dislocation.【Methods】 18 cases of patients with recurrent patellar dislocation were treated with arthroscopic lateral patellofemoral retinaculum loosenin and medial patellofemoral ligament reconstruction with gautologous semitendinosus tendon, simultaneously with Fulkerson tibial tubercle osteotomy.The recurrent patellar dislocation and knee limb subjective symptoms and overall functional rehabilitation were followed-up postoperative. 【Results】All patients were satisfactory followed up for 6～24 months, with an average follow-up time of 12.7 months. No recurrence of patellar dislocation. Postoperative X-ray comparison, patella-femoral trochlear angle was improved from preoperative（25.8±6.9）° to（1.5±7.1）°（ P〈0.01）, the outer surface patella opening angle from（-1.3±6.2）° to（12.8±3.9）°（ P〈0.01）. Lysholm knee score after a year was（94.7±3.1） points, significantly higher（65.6±4.6） points（ P〈0.05）; Kujala score after a year was（91.6±3.1） points, also significantly higher（60.3±3.3） points（ P〈0.05）. After a year Insall kneewas scored based on criteria, 13 knees were excellent, 4 good knees, the excellent rate was 94.4%. 【Conclusion】Arthroscopic lateral patellofemoral retinaculum loosenin and medial patellofemoral ligament reconstruction with gautologous semitendinosus tendon, simultaneously with Fulkerson tibial tubercle osteotomy can effectively treat recurrent patellar dislocation, and contribute to relieve symptoms, restore knee function.