髌内侧支持带修复术治疗急性髌骨脱位的临床研究

Clinical study on repair of medial retinaculum for treatment of acute patellar dislocation

目的观察采用带线锚钉行髌内侧支持带修复术治疗累及髌骨止点损伤急性髌骨脱位的临床疗效。方法回顾性分析自2011-01—2015-06累及髌内侧支持带髌骨止点损伤的17例初次急性髌骨脱位,5例髌内侧支持带纤维从髌骨上直接撕脱,12例髌内侧支持带连同髌骨内缘骨片撕脱,采用带线锚钉对髌内侧支持带进行修复。结果 17例均获得至少2年随访,术后髌骨不稳消失,髌骨恐惧症阴性,髌骨外推止点感明确。术后10周最大主动屈膝角度为(132.6±5.6)°,与正常人参考值135°比较差异无统计学意义(P>0.05)。术后2年髌骨倾斜角为(8.9±1.0)°,较术前(11.6±1.4)°明显改善,差异有统计学意义(P<0.05)。术后2年锚钉尖与髌骨外缘间距为(23.4±1.3)mm,与术后1周(23.6±1.5)mm比较差异无统计学意义(P>0.05)。术后2年膝关节功能Kujala评分为(97.5±1.7)分,较术前(84.1±5.6)分明显提高,差异有统计学意义(P<0.05)。结论对于髌内侧支持带髌骨止点损伤的急性髌骨脱位患者,为了避免向复发性髌骨脱位发展,在伤后3周内采用带线锚钉行髌内侧支持带修复术治疗的短期效果良好。

Objective To study therapeutic effect of medial retinaculum repair by bone anchor mated suture for acute patellar dislocation combined with injury of medial patellar retinaculum attachment to patella. Methods From January 2011 and June 2015, a retrospective analysis of 17 clinical cases of primary acute patellar dislocation combined with injury of medial patellar retinaculum attachment to patella was conducted. In five cases, medial patellar retinaculum's fibers were detached from patellar edge. In twelve cases, bone debris attached to medial patellar retinaculum was detached from patella edge. The medial patellar retinaculum was stitched into patellar medial edge by bone anchor mated suture in all patients.Results Seventeen cases were followed up for at least 2 years. After operation, all patients didn't experience patella instability. Apprehension tests were negative and lateral movement of patella pushed by fingers had terminal. In the tenth week after operation, maximal angle of active knee flexion was(132.6 ±5.6)°, there were no significant differences compared with normal range of 135°(P >0.05). Patellar tilt angles of 2 years later after surgery were(8.9±1.0)°, which were better than(11.6 ±1.4)° before operation, there were significant differences(P <0.05). Length between bone anchor and lateral edge of patella of 2 years later after surgery were(23.4±1.3) mm, there were no significant differences compared with(23.6±1.5) mm of first week after surgery(P >0.05). Kujala scores of 2 years after operation were(97.5 ±1.7), which were better than(84.1 ±5.6) before operation, there were significant differences(P <0.05). Conclusion The medial retinaculum repair by bone anchor mated suture has good therapeutic short-term effects for acute patellar dislocation with injury of medial patellar retinaculum attachment to patella. It should be performed in 3 weeks after injury to avoid recurrent patellar dislocation.