关节镜下内侧髌股韧带重建联合半胫骨结节内移术治疗复发性髌骨脱位

Arthroscopic reconstruction of medial patellofemoral ligament combined with medial displacement of lateral hemitibial tuberosity for treatment of recurrent dislocation of patella

目的观察关节镜辅助下取自体腓骨长肌腱外侧半经髌骨单隧道单束单股重建内侧髌股韧带(medial patellofemoral ligament,MPFL),结合外侧半胫骨结节内移术治疗复发性髌骨脱位的临床疗效。方法回顾分析2014年9月—2018年9月收治的24例(24膝)胫骨结节-股骨滑车沟间距(tibial tuberositytrochlear groove distance,TT-TG)值>15 mm的复发性髌骨脱位患者临床资料。其中男7例,女17例;年龄16~35岁,平均25.8岁。病程15~46个月,平均26.7个月。患者均有患膝关节外伤史,患侧膝关节恐惧试验阳性。关节镜辅助下,取自体腓骨长肌腱外侧半经髌骨单隧道单束单股重建MPFL,同时结合外侧半胫骨结节内移术治疗。手术前后采用Kujala评分评价髌股关节功能,采用Lysholm评分评价膝关节功能;采用CT、MRI测量并比较髌股适合角(congruence angle,CA)、髌骨倾斜角(patellar tilt angle,PTA)及外侧髌骨移位值(lateral patella displacement,LPD)变化情况,评价髌骨稳定性。结果术后患者切口均Ⅰ期愈合,无感染及神经血管损伤等并发症发生。2例分别于术后4、7 d出现下肢深静脉血栓形成,经对症处理后血栓消失。24例患者均获随访,随访时间12~14个月,平均12.9个月。随访期间患侧膝关节均未再发生髌骨脱位;末次随访时患者恐惧试验均为阴性。末次随访时,患者膝关节TT-TG值、CA、PTA、LPD均较术前显著改善(P<0.05)。术后1个月和末次随访时患者髌股关节Kujala评分及膝关节Lysholm评分均优于术前,且末次随访时上述评分优于术后1个月,差异均有统计学意义(P<0.05)。根据Lysholm评分,末次随访时患者患膝关节功能获优13例、良10例、可1例,优良率95.8%。结论关节镜辅助下取自体腓骨长肌腱外侧半经髌骨单隧道单束单股重建MPFL,结合外侧半胫骨结节内移治疗复发性髌骨脱位,具有创伤小、疗效可靠等优点,是一种有效手术方式。

Objective To observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament(MPFL)with a single bundle of autogenous half peroneal longus tendon,and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella.Methods Retrospectively analyse the clinical data of 24 patients(24 knees)with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance(TT-TG)values more than 15 mm who were admitted between September 2014 and September 2018.Of which 7 were male and 17 were female;aged 16-35 years old with an average of 25.8 years.The disease duration ranged from 15 to 46 months,with an average of 26.7 months.All patients had a history of knee trauma,and a positive result of apprehension test on the affected knee.All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon,and medial displacement of lateral hemitibial tuberosity.Before and after operation,Kujala score was used to evaluate patellofemoral joint function,Lysholm score was used to evaluate knee joint function;CT and MRI were used to measure and compare the changes of congruence angle(CA),patellar tilt angle(PTA),and lateral patella displacement(LPD)in order to evaluate patella stability.Results All incisions healed by first intention,and no infection or neurovascular injury occurred.Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively,and the thrombosis disappeared after symptomatic treatment.All the 24 patients were followed up 12-14 months(mean,12.9 months).During follow-up,no patellar dislocation reoccurred in the affected knee.At last follow-up,the apprehension test was negative in every patients.The TT-TG,CA,PTA,and LPD were significantly improved when compared with those before operation(P<0.05).The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation,and the above scores at last follow-up were significantly better than those at 1 month after operation(P<0.05).According to Lysholm score,the patients’knee joint functions were excellent in 13 cases,good in 10 cases,and fair in 1 case,and the excellent and good rate was 95.8%.Conclusion Arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness.It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.