关节镜下内侧髌股韧带双束解剖重建治疗青少年复发性髌骨脱位的临床研究

Therapeutic effects of double-bundle anatomical medial patello femoral ligament reconstruction under arthroscope in treatment of recurrent dislocation of patella in adolescents

目的分析应用关节镜下内侧髌股韧带(medial patello femoral ligament,MPFL)双束解剖重建治疗青少年复发性髌骨脱位的临床疗效。方法对2015年1月至2017年1月因反复性髌骨脱位患者40例行关节镜下MPFL双束解剖重建术,术后实施快速康复方案,随访1年,比较术前、术后6个月、术后1年外侧髌股角、Q角、Congruence角和Sulcus角;并依据Lysholm膝关节功能评分、Kujala主观评分和Tegner运动功能进行综合评定。结果40例患者均得到随访,术后髌骨轴位X线片和CT片均示髌股关节解剖关系恢复正常,无骨骺早闭合,无伤口感染、切口均Ⅰ期愈合,无髌骨再次脱位,髌骨外推恐惧试验均为(-),92.5%(37/40)患者对手术效果非常满意,7.5%(3/40)对手术效果满意。术前、术后6个月、术后1年Q角、Congruence角和Sulcus角与术前比较均降低(P<0.05);外侧髌股角、Lysholm、Kujala和Tegner评分与术前比较均增高(P<0.05)。结论关节镜下MPFL双束解剖重建术能够恢复复发性髌骨脱位患者膝关节局部生物力学,维持局部动静力平衡,对于骨骺未闭青少年患者是一种安全、有效、可靠的手术技术。

Objective To investigate the therapeutic effects of double-bundle anatomical medial patello femoral ligament(MPFL)reconstruction under arthroscope in treatment of recurrent dislocation of patella in adolescents.Methods A total of 40 patients with recurrent dislocation of patella who underwent double-bundle anatomical medial patello femoral ligament reconstruction under arthroscope in our hospital from January 2015 to January 2017 were enrolled in the study,who were treated by quick rehabilitation scheme after the operation,and were followed up for 1 year.The changes of lateral patello femoral angle,Q angle,Congruence angle and Sulcus angle before operation,at 6 months and 1 year after surgery were observed,moreover,the therapeutic effects were evaluated according to Lysholm knee joint function score,Kujala subjective score and Tegner motor function.Results All the patients were followed up,after operation,the anatomical relationship of patello femoral joint showed by X-ray and CT was normal,without early epiphyseal closing and wound infection.All the incisions had stage healing,without patellar dislocation again,and the fear test of patellar extrapolation was(-),and 92.5%(37/40)of patients were quite satisfied with the operation results,and 7.5%(3/40)of patients were satisfied with the operation results.The Q Angle,Congruence angle and Sulcus angle at 6 months and 1 year after surgery were decreased,as compared with those before operation,however,the lateral patello femoral angle,Lysholm,Kujala and Tegner scores were significantly increased(P<0.05).Conclusion The double-bundle anatomical medial patello femoral ligament reconstruction under arthroscope can restore the local biomechanics of the knee joint of patients with recurrent patellar dislocation and maintain the balance of static and static forces,which is a safe,effective and reliable surgical technique for the adolescent patients with epiphysis patency.