MPFL髌骨止点缝合修复法治疗合并骨软骨骨折的青少年初次髌骨脱位疗效观察

Juvenile Patellar Dislocation with Osteochondral Fracture Treated with MPFL Repair Method

目的:回顾分析内侧髌股韧带(Medial Patellofemoral Ligament,MPFL)的髌骨止点缝合修复方法,对于合并骨软骨骨折的青少年初次髌骨脱位的治疗效果。方法:2014年1月至2017年6月收治的12例急性初次髌骨脱位患者,男7例,女5例,年龄11~17岁(平均14±3.1岁),左侧9例,右侧3例。伤后2周内全身麻醉下行手术治疗,将骨软骨骨折复位内固定后,以两枚缝合锚钉打入髌骨内上缘,修整包含MPFL的髌骨内侧支持带,将其褥式缝合修复于髌骨内侧。对比术前术后6个月及末次随访时的恐惧试验、髌骨外推试验,并通过Lysholm、Kujala及Tegner评分评价患侧膝关节功能。结果:所有患者随访12~16个月(平均14.2±2.5个月),2例患者恐惧试验和髌骨外推试验均阳性,无再次脱位发生,末次随访Lysholm、Kujala及Tegner评分均较术前明显增加(P<0.05),膝关节功能恢复良好。结论:MPFL髌骨止点缝合修复法治疗合并骨软骨骨折的青少年初次髌骨脱位,方法简单,创伤小,近期疗效满意。

Objective:To retrospective a patellar end insertion repair method of Medial Patellofemoral Ligament(MPFL)to primary patellar dislocation in adolescents with osteochondral fracture.Methods:From January 2014 to June 2017,12 cases of acute primary patellar dislocation from Second Affiliated Hospital of Xi'an Jiao Tong University were enrolled in the study,including 7 males and 5 females,with an average age of 14±3.1 years years(11~17 years old),9 left knees and 3 in the right.All the patients were treated within 2 weeks after injury surgical treatment was performed under general anesthesia,After internal fixation of osteochondral fracture,2 suture anchors were inserted into the upper 1/3 of media side of patellar to repair MPFL,and suture the injury side of MPFL on the medial patella.The apprehension sign and patellar hypermobility were compared at 6 months and last follow-up.Patients were evaluated postoperatively with the Kujala scoring questionnaire,Lysholm scores and Tegner scores.Results:All patients were followed up for 12~16 months(average 14.2±2.5 months),2 patients were positive apprehension sign and patellar hypermobility,no recurrent dislocation occurred.Lysholm,Kujala and Tegner scores were significantly increased(P<0.05),and the knee joint function recovered well at last follow-up.Conclusion:MPFL patellar end suturing repair method is simple and minimally invasive for the treatment of primary dislocation of patella in adolescents with osteochondral fracture.