股内侧肌悬吊髌骨单锚钉双束解剖重建内侧髌股韧带

Double-bundle anatomic reconstruction of medial patella femoral ligament by vastus medialis suspension combined with patellar single anchor

[目的]介绍股内侧肌悬吊髌骨单锚钉双束解剖重建内侧髌股韧带(MPFL)治疗复发性髌骨脱位的技术方法。[方法]2013年1月~2016年6月收治的复发性髌骨脱位患者19例。手术以股骨内上髁、收肌结节与腓肠肌结节之间的凹陷作为MPFL股骨止点,建立直径6 mm、深40 mm骨隧道;髌骨内缘中点做髌骨侧止点,沿髌骨长轴建立约1 cm的骨槽,在中点平行于髌骨关节面打入1枚带双线4.5 mm锚钉,将移植物固定于骨槽并与周围软组织缝合。移植物近侧游离端穿过股内侧肌斜束肌腱,形成"悬吊"结构并自股骨侧切口下穿出,远侧游离端在深筋膜隧道自近端移植物同一位置穿出,远近端缝合为一股端,于骨道内口用可吸收界面螺钉固定。[结果]术后随访12~48个月。未发生感染、膝关节功能障碍、复发等相关并发症。末次随访时膝关节功能Lysholm、IKDC、Kujala和Tegner评分均较术前显著增加,差异有统计学意义(P<0.05);末次随访时CA、Q角、PTA、PLSR均较术前显著减小,差异有统计学意义(P<0.05)。[结论]股内侧肌悬吊髌骨拴桩双束解剖重建内侧髌股韧带切口小、复发率低,可恢复髌股轨迹的动力和静力稳定性,临床疗效满意。

[Objective] To introduce surgical technique of double-bundle anatomic reconstruction of medial patellofemoral ligament (MPFL) by vastus medialis suspension combined with patellar single anchor.[Methods] From January 2013 to June 2016, 19 patients were surgically treated for recurrent patellar dislocationin our department. The femoral tunnel of 6 mm in diameter and 40 mm in depth was created at the recess between adductor and gastrocnemius tubercle on medial femoral epicondyle, while patellar insertion was made on the midpoint of the medial patellar border with a 1 cm longitudinal bone slot and an anchor 4.5 mm in diameter placed. The midpart of tendon graft was secured with the anchor suture and surround soft tissues, and then the proximal free end was passed through the vastus medialis to form a suspension on the muscle. After that, both the free ends of the graft was passed under deep fascia and introduced into the femoral tunnel. Finally, the reconstructed MPFL was secured at the femoral insertion with an interference screw under proper tension.[Results] All patients were followed up for 12- 48 months. No complications, such as infection, knee dysfunction, and recurrence of patellar subluxation happened in anyone of them. At the latest follow-up, the Lysholm, IKDC, Kujala, and Tegner scores of the knee joint function were significantly increased compared with those before surgery (P<0.05). In addition, the radiographic measurements, including congruence angle (CA), Q angle, patellar tilt angle (PTA), patellar lateral shift ratio (PLSR), significantly decreased at the latest interview compared with those preoperatively (P<0.05).[Conclusion] The double-bundle anatomic reconstruction of MPFL by vastus medialis suspension combined with patellar single anchor does achieve satisfactory clinical outcomes with advantages of minimized incision, reduced recurrence and simultaneous restoration of both the dynamic and static stability of patellofemoral trajectory.