内侧髌股韧带重建治疗髌骨不稳临床效果观察

Medial patellofemoral ligament reconstruction in patients with patellar instability

目的观察内侧髌股韧带重建治疗髌骨不稳的临床效果。方法选取上海市第一人民医院自2011年6月至2012年6月收治的36例髌骨不稳综合征患者为研究对象,将患者随机分入A、B两组,每组各18例。A组患者行单纯髌骨外侧支持带松解术,B组患者利用双股自体半腱肌肌腱重建内侧髌股韧带。对所有患者进行随访,采用Crosby-Insall评分、Lysholm评分及膝关节活动度评估两组患者的治疗效果。结果患者中位随访时间为19.6个月,无失访。在Crosby-Insall评分方面,A组7例优秀,4例良好,3例尚可,4例较差,优良率为61.1%(11/18);B组14例优秀,3例良好,1例尚可,优良率为94.4%(17/18),两组比较,差异有统计学意义(P<0.05)。在Lysholm评分方面,A、B两组术前分别为(65.0±4.2)分、(63.6±5.5)分,两组比较,差异无统计学意义(P>0.05);术后即刻分别为(88.4±3.3)分、(94.7±3.5)分,两组比较,差异有统计学意义(P<0.05);术后1年分别为(81.6±3.1)分、(93.4±4.2)分,两组比较,差异有统计学意义(P<0.05);且两组术后即刻、术后1年的Lysholm评分与术前比较,差异均有统计学意义(P<0.05)。在膝关节活动度(髌骨平均倾斜角)方面,A、B两组术前分别为(33.6°±2.5°)、(32.7°±2.8°),两组比较,差异无统计学意义(P>0.05);术后即刻分别为(10.8°±2.8°)、(4.3°±1.8°),两组比较,差异有统计学意义(P<0.05);术后1年分别为(16.5°±4.3°)、(6.5°±2.2°),两组比较,差异有统计学意义(P<0.05);且两组术后即刻、术后1年的髌骨平均倾斜角与术前比较,差异均有统计学意义(P<0.05)。两组患者均未发生感染或神经血管并发症;A组中有3例患者复发髌骨脱位,B组中未出现。结论单纯髌骨外侧支持带松解术和内侧髌股韧带重建均能有效治疗髌骨不稳,但内侧髌股韧带重建在纠正髌骨异常倾斜、缓解症状、维持髌骨稳定性方面均优于单纯髌骨外侧支持带松解术。

Objective To retrospectively study the patients of patellar instability with different surgical treatments to determine the effective one. Methods Totally 36 patients received from June 2011 to June 2012 with patellar instability were randomly divided into two groups. Patients in Group A（ n = 18） were treated with lateral patellar retinaculum release,and Group B（ n = 18） was treated with medial patellofemoral ligament（ MPFL） reconstruction with semitendinosus autograft. Then evaluated the outcomes based on CrosbyInsall criteria,Lysholm scoring scale and range of motion. Results All patients were followed-up with mean time of 19. 6 months. According to Crosby-Insall criteria,cases in Group A were evaluated 7 excellent,4 good,3 fair and 4 poor,Group B had 14 excellent,3 good and 1 fair. The outcome was significantly better in Group B than in Group A. Compared with Group A,Group B had significantly higher Lysholm score and range of motion 1 year after surgery. Moreover,3 cases in Group A had recurrent patellar dislocation,which was not observed in Group B. Conclusion Lateral patellar retinaculum release and MPFL reconstruction with semitendinosus autograft can both effectively treat patellar instability. However,MPFL reconstruction is more effective than lateral patellar retinaculum release in the treatment of abnormal movement of patellofemoral joint and maintaining patellar stability.