内侧髌股韧带联合髌胫韧带重建治疗复发性髌骨脱位

Treatment of Recurrent Patellar Dislocation Viamedial Patellafemoral Ligament and Medial Patellotibial Ligament Reconstruction

目的评价用半腱肌腱重建内侧髌股韧带和用髌韧带内1/3重建髌胫韧带治疗复发性髌骨脱位的临床疗效和影像学结果。方法回顾性分析我科2013年6月至2018年6月收治的25例复发性髌骨脱位患者,其中男性6例,女性19例;年龄15~38岁,平均(22.36±5.20)岁。全部患者均在麻醉下取半腱肌肌腱重建髌股韧带,取髌韧带内1/3带胫骨结节骨块重建髌胫韧带。术后复查CT和X线,测量髌骨-股骨适配角、髌骨倾斜角,髌骨外移度、Caton指数、胫骨结节-股骨滑车沟(tibial tubercle-trochlear groove,TT-TG)距离值作为影像学评价;以膝关节功能Lyshlom评分、Kujala评分、J形征和恐惧试验作为临床疗效评价。结果25例患者均获得随访,随访时间12~48个月,平均(18.16±6.85)个月。患者术后均未再次脱位。Kujala评分:术前(54.60±11.08)分,术后(75.40±7.49)分;Lysholm评分:术前(43.48±6.78)分,术后(93.20±3.52)分;手术前后比较差异有统计学意义(P<0.05)。影像学检查结果提示,髌骨-股骨适配角:术前(13.74±5.09)°,术后(4.14±2.52)°;髌骨倾斜角:术前(16.89±4.09)°,术后(3.40±1.37)°;髌骨外移度:术前(33.14±3.99)mm,术后(7.40±2.69)mm;手术前后比较差异有统计学意义(P<0.05)。TT-TG值、Caton指数手术前后比较差异无统计学意义(P>0.05)。查体J形征阴性,恐惧试验阴性。结论本研究采用半腱肌肌腱重建髌股韧带联合髌韧带内1/3重建髌胫韧带治疗复发性髌骨脱位,在技术上是安全,可在短期随访时间内取得良好的临床效果。

Objective To evaluate the clinical efficacy and imaging results of reconstruction of the medial patellofemoral ligament with semitendinotendon and the medial patellotibial ligament with medial 1/3 of the patellar ligament in the treatment of recurrent patellar dislocation.Methods This study retrospectively analyzed 25 patients diagnosed with recurrent patellar dislocation who were admitted from Jun.2013 to Jun.2018,including 6 males and 19 females.The age ranged from 15 to 38 and the average age was(22.36±5.20).Semitendinosus tendon was taken to reconstruct patellofemoral ligament under anesthesia,medial 1/3 of the patellar ligament connected with bone block from tibial tubercle was taken to reconstruct patellotibial ligament.CT-scan and X-ray examination were reexamined post-operation as imaging evaluation,and the patellar femoral adaptation Angle,patella inclination angle,patella migration degree,Caton index,TT-TG value(Tibia Tuberosiy-Trochlear Groove)were measured.Lyshlom score,Kujala score,J-sign and apprehensive test were used to evaluate Knee function.Results All of the 25 participants were followed up for 12 to 48 months,with an average of(18.16±6.85)months.No recurrent dislocation was reported.The preoperative and postoperative Kujala score was(54.60±11.08)and(75.40±7.49)separately,the Lysholm score was(43.48±6.78)and(93.20±3.52)respectively,and the difference was statistically significant(P<0.05).According to the imaging evaluation,the patellar femoral adaptation Angle was(13.74±5.09)°and(4.14±2.52)°in pre-operation and pos-topration,the patellar tilt Angle was(16.89±4.09)°and(3.40±1.37)°respectively,the offshoring of patellar degrees was(33.14±3.99)and(7.40±2.69)respectively,and the differences were statistically significant(P<0.05).No statistically significant difference was found when TT-TG values and Caton index were compared before and after operation(P>0.05).J-signs were negative and Apprehensive tests were negative for all the patients.Conclusion The reconstruction of patellofemoral ligament with semitendinoid combined with reconstruction of patellotibial ligament with 1/3 of the patellar ligament connected with bone block from tibial tubercle in this study is technically safe for the treatment of recurrent patellar dislocation,and has achieved good clinical results both subjectively and objectively in the short-term follow-up.