大收肌腱移位双束重建内侧髌股韧带联合全髌腱止点上移治疗青少年习惯性髌骨脱位

A combined method of proximalization of the patella tendon and double boundle reconstruction of medial patellofemoral ligament with adductor magnus tendon autograft for the treatment of habitual dislocation of patella in adolescent

目的探讨大收肌腱移位双束重建内侧髌股韧带(MPFL)联合全髌腱止点上移手术治疗骨骺尚未闭合且合并严重股四头肌挛缩的青少年习惯性髌骨脱位(HDP)患者的手术技术和临床效果。方法对2016年8月至2018年8月在北京积水潭医院接受手术治疗的33例(37膝)骨骺尚未闭合的HDP患儿进行回顾性分析。其中,10例(12膝)合并严重股四头肌挛缩需要进行上述手术方式治疗,其中男4例,女6例,年龄10~14岁,平均(12.1±1.4)岁。术前及末次随访时进行Lysholm评分、临床查体及膝关节影像学检查,通过X线平片的适合角及外侧髌骨角评估髌股关节对合关系。结果10例(12膝)患儿平均随访23个月(12~36个月)。所有患儿术后6个月随访时膝关节活动度均恢复正常,均未出现感染及髌骨再次脱位等并发症,Lysholm评分由术前的77±9改善为末次随访时的96±6(t=−23.155,P<0.05)。髌股关节适合角由术前的72.4°±17.2°改善到末次随访的-7.5°±4.8°(t=21.392,P<0.01),外侧髌股角由-64.6°±9.4°改善为6.5°±3.7°(t=-22.874,P<0.01)。结论大收肌腱移位双束重建内侧髌股韧带联合全髌腱止点上移治疗骨骺尚未闭合且合并严重股四头肌挛缩的青少年习惯性髌骨脱位初期效果满意。

Objective To present the technique and clinic effect of the combined method of proximalization of the patella and double boundle reconstruction of medial patellofemoral ligament(MPFL)with adductor magnus tendon autograft for the treatment of habitual dislocation of patella(HDP)in adolescent.Methods From August 2016 to August 2018,a total of 33 consecutive skeletally immature adolescent patients(37 knees)with HDP were surgically treated in Beijing Jishuitan Hospital and were retrospectively reviewed.Among them,10 patients(12 knees)with severe quadriceps contracture underwent the index comprehensive procedure.There were 4 males and 6 females with a mean age of(12.1±1.4)years(10 to 14 years old)at the operation.Before surgery and at the final follow-up,subjective symptoms were scored by Lysholm knee score,physical examination and radiological assessment were performed.Results of patellar tracking were assessed by congruence angle and lateral patellofemoral angle.Results Patients were followed up for an average period of 23 months(12-36 months).No infection,patella redislocation were observed in all cases.Lysholm scores improved from 77±9 before surgery to 96±6 at the final follow-up(t=−23.155,P<0.05).There was a statistically significant improvement in the congruence angle,from 72.4°±17.2°preoperatively to-7.5°±4.8°at the final follow-up(t=21.392,P<0.01)and in the lateral patellofemoral angle,from-64.6°±9.4°preoperatively to 6.5°±3.7°at the final follow-up(t=-22.874,P<0.01).Conclusion In this short term study,the novel comprehensive procedure,including proximalization of the patella and double boundle reconstruction of MPFL with adductor magnus tendon autograft,treats HDP effectively in skeletally immature adolescent patients with severe quadriceps contracture.