内侧髌股韧带重建术联合胫骨结节截骨术治疗伴高位髌骨复发性髌骨脱位的临床疗效

Clincical efficacy of medial patellofemoral ligament reconstruction combined with tibial tuberosity osteotomy in treatment of recurrent patellar dislocation associated with patella alta

目的比较内侧髌股韧带重建术（MPFLR）联合胫骨结节截骨术（TTO）与单纯TTO治疗伴高位髌骨复发性髌骨脱位的疗效。方法采用回顾性病例对照研究分析2010年7月-2015年12月收治的50例伴高位髌骨复发性髌骨脱位患者临床资料，其中男15例，女35例；年龄13～29岁，平均20．6岁。根据手术方式将患者分为TTO组（32例）和MPFLR＋TTO组（18例）。末次随访时对患者进行髌骨稳定性检查，并比较手术前后Tegner活动指数量表、国际膝关节文献委员会膝关节主观评价表（IKDC）、髌骨Kujala评分、膝关节损伤和骨关节炎结果评分（KOOS）。结果术后随访时间分别为TTO组（50．9±17．8）个月和MPFLR＋TTO组（24．3±10．1）个月（P〈0．05）。TTO组术后髌骨脱位2例，患侧膝关节0°位髌骨外推试验和外推恐惧试验均为阳性；MPFLR＋TTO组术后无髌骨脱位发生，患侧膝关节0°位髌骨外推试验和外推恐惧试验均为阴性。末次随访时，TTO组Tegner评分和KOOS疼痛子域及日常生活活动子域评分较术前差异无统计学意义（P〉0．05），而其余各项评分差异均有统计学意义（P〈0．05）。MPFLR＋TTO组术后各项评分较术前差异均有统计学意义（P〈0．05）；且术后KOOS疼痛子域及日常生活活动子域评分较TTO组有显著改善（P〈0．05）。结论对于伴高位髌骨复发性髌骨脱位患者，两种手术方式均可获得较术前满意的疗效；TTO术后疼痛和日常生活活动较术前改善不明显，MPFLR＋TTO术后疼痛和日常生活活动的改善要优于TTO。

Objective To compare the efficacy of tibial tuberosity osteotomy （TTO） combined with medial patellofemoral ligament reconstruction （MPFLR） with simple TTO in treatment of recurrent patella dislocation associated with patella alta. Methods From July 2010 to December 2015, 50 patients with recurrent patella dislocation and patella aha were included in this study. There were 15 males and 35 females with an average age of 20.6 years. These patients received surgical treatment and their clinical data were collected and retrospectively analyzed by case-control study. According to surgical methods, patients were divided into TTO group （32 cases） and MPFLR ＋ TTO group （18 cases）. The differences between preoperative status and postoperative status were evaluated by knee function scores including Tegner, international knee documentation committee （IKDC）, Kujala scores, knee injury and osteoarthritis outcome score （KOOS）. Patellar stability was checked at the last follow-up visit. Results The TTO group and MPFLR ＋ TTO group were followed up for （50.9 ± 17.8 ） months and （22. 3± 10. 1 ） months, respectively. Two patients occurred recurrent dislocation in TTO group, who showed positive in both extrapolation test and extrapolation apprehension test at 0° flexions of knee. All patients in MPFLR ＋ TTO group did not occur recurrent dislocation, who showed negative in both extrapolation test and extrapolation apprehension test at 0° flexions of knee. There was no significant difference between preoperative and postoperative results in TTO group in Tegner score （ P 〉 0.05 ） , KOOS scores in pain and daily life activities subdomains （P 〉 0.05 ） , while differences in the rest of scores were statistically significant （P 〈 0.05）. Compared with TTO group, the differences of all scores were statistically significant （P 〈 0.05 ） and KOOS scores in the pain and daily life activities subdomains were significantly improved postoperatively in MPFLR ＋ TTO group （P 〈 0. 05）. Conclusions For patients with recurrent patellar dislocation associated with patella aha, both surgical methods are found to be effective. Postoperative improvements in pain and daily life activities are less obvious in TTO. While postoperative improvements in pain and daily life activities in MPFLR ＋ TTO are superior to those of TTO.