关节镜下双束重建内侧髌股韧带联合半髌韧带内移治疗骨骺未闭合青少年复发性髌骨脱位

Arthroscopic double-bundle reconstruction of medial patellofemoral ligament plus medial transposition of lateral half patellar tendon for treatment of recurrent dislocation of patella in skeletally immature adolescents

目的探讨关节镜下自体半腓骨长肌腱双束重建内侧髌股韧带联合半髌韧带内移手术治疗骨骺未闭合青少年复发性髌骨脱位的临床疗效。方法回顾性分析自2016-07—2018-09诊治的20例骨骺未闭合且胫骨结节-股骨滑车沟间距>20 mm的青少年复发性髌骨脱位,在关节镜下采用自体半腓骨长肌腱经大收肌肌腱止点悬吊双束重建内侧髌股韧带联合半髌韧带内移手术治疗。结果 20例均获得随访,随访时间平均21.2(12~36)个月。所有患者术后复查均未再发生髌骨脱位或半脱位,膝关节功能恢复满意。末次随访时髌股适合角为(-1.79±3.26)°,髌骨倾斜角为(11.11±1.08)°,较术前明显减小;末次随访时膝关节功能Lysholm评分为(94.60±2.58)分,髌股关节功能Kujala评分为(91.05±2.33)分,较术前明显提高,差异有统计学意义(P<0.05)。结论对于骨骺未闭合且胫骨结节-股骨滑车沟间距>20 mm的青少年复发性髌骨脱位患者,关节镜下采用自体半腓骨长肌腱双束重建内侧髌股韧带联合半髌韧带内移手术治疗可获得稳定的髌骨滑动轨迹,髌骨脱位矫正良好。

Objective To investigate the clinical efficacy of arthroscopic double-bundle reconstruction of medial patellofemoral ligament(MPFL)with half autogenous peroneus longus tendon plus medial transposition of lateral half patellar tendon for the treatment of recurrent dislocation of patella in the skeletally immature adolescents.Methods A retrospective analysis of 20 cases of recurrent patellofemoral dislocation in skeletally immature adolescents with tibial tuberosity-trochlear groove(TT-TG)spacing greater than 20 mm diagnosed and treated from July 2016 to September 2018 was conducted.Under arthroscopy,they were treated with double-bundle reconstruction of MPFL using the anterior half of the autogenous peroneus longus tendon through insertion of adductor magnus tendon,and plus medial transposition of lateral half patellar tendon.Results All 20 patients were followed up for average 21.2(12-36)months.No patellar dislocation or subluxation occurred in the postoperative reexamination,and the knee function of the patients recovered satisfactorily.At the last follow-up,the congruence angle was(-1.79±3.26)°and the patellar tilt angle was(11.11±1.08)°,which was significantly smaller than that before surgery;At the last follow-up,the Lysholm score of knee function was(94.60±2.58)points,and the Kujala score of patellofemoral joint function was(91.05±2.33)points,which was significantly higher than that before surgery,and the difference was statistically significant(P<0.05).Conclusion For skeletally immature adolescent patients with recurrent patellofemoral dislocation and TT-TG spacing greater than 20 mm,arthroscopic double-bundle reconstruction of MPFL with half autogenousperoneallongus tendon plus medial transposition of lateral half patellar tendon can obtain stable patellar sliding track,patellar dislocation correction is good.