软组织固定重建内侧髌股韧带治疗青少年复发性髌骨脱位

Soft-tissue Fixation of Medial Patellofemoral Ligament Reconstruction for Treatment of Recurrent Dislocation of the Patella in Adolescents

目的:分析应用软组织固定技术重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗青少年复发性髌骨脱位的临床疗效。方法:2014年3月至2016年10月期间对12例诊断为复发性髌骨脱位的青少年患者,取自体半腱肌腱行MPFL重建术。全部运用软组织固定技术完成重建。术后实施快速康复方案。术前及术后随访期间根据Lysholm、IKDC和Kujala膝关节功能评分评估临床效果。调查患者术后满意度及恢复体育活动情况。结果:所有患者均获得随访,时间为6~18个月(平均12个月)。全部12例患者均无再发脱位,最终随访时均恢复全范围活动度和正常的内侧结构稳定。术后Lysholm、IK-DC和Kujala膝关节功能评分均较术前有显著提高(P<0.01)。10例患者对手术效果非常满意,其余2例为满意。75%(9/12)的患者术后6月后可以恢复术前的体育运动水平(均非专业运动员)。结论:应用软组织固定技术重建MPFL获得了显著的临床疗效。该方法避免了骨隧道及内植入物的相关并发症。对于骨骺未闭的青少年患者,是一种安全、有效、牢靠的手术技术。

Objective To explore the efficacy of the soft-tissue fixation in reconstruction of the medial patellofemoral ligament（MPFL） in treating the recurrent dislocation of patella in adolescents. Methods A total of 12 adolescents undergoing MPFL reconstruction for the recurrent dislocation of patella between March 2014 and October 2015 were included. The autologous hamstring tendon was harvested and fixated using the soft-tissue fixation method in the MPFL reconstruction. A rapid rehabilitation program was carried out postoperatively. Clinical outcomes were evaluated using the Lysholm,international knee documentation committee（IKDC）,Kujala knee scores preoperatively and during the postoperative follow-up. Moreover,the degree of satisfaction to the surgery and the restoration of sports activitieswere also surveyed. Results All patients were followed up for 6 to 18 months,with an average of 12 months. There was no recurrence of dislocation. During the final follow-up,all patients restored the full range of activity and normal medial patellar stability. The Lysholm,IKDC and Kujala knee scores were significantly improved postoperatively compared with those preoperatively（P〈0.01）. Ten patients were very satisfied with the operation and the other 2 were satisfied with the surgery. Among all the patients（non-professional athletes）,75%（9/12） fully regained their sport abilities in 6 months after the surgery. Conclusions Reconstruction of MPFL with the soft-tissue fixation method has achieved remarkable clinical results without severe complications associated with bony procedures. For the adolescent patients with open growth plates,this is a safe,effective and reliable surgical technique.