经骨缝合与缝合锚钉技术在内侧髌股韧带双束重建术中应用的比较研究

Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction

目的探讨经骨缝合术在内侧髌股韧带(medial patellofemoral ligament,MPFL)双束重建术中应用的效果。方法回顾分析2014年1月—2017年12月收治且符合选择标准的75例复发性髌骨脱位患者临床资料,均采用MPFL双束重建术治疗,根据术中固定技术分为研究组(39例,新型经骨缝合术)和对照组(36例,传统缝合锚钉固定)。两组患者性别、年龄、身体质量指数、患膝侧别以及术前胫骨结节-滑车沟距离、Insall-Salvati比值、膝关节活动度、Kujala评分、国际膝关节文献委员会(IKDC)评分、适合角、倾斜角等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、术后并发症等情况。手术前后采用Kujala评分、IKDC评分及膝关节活动度评价患者功能改善情况;于X线片上测量适合角、倾斜角。结果两组患者手术时间、术中出血量、住院时间比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间24~36个月,平均29.4个月。随访期间均未出现切口感染、脂肪液化,髌骨再脱位及髌前疼痛等并发症。末次随访时,两组患者Kujala评分、IKDC评分、膝关节活动度、适合角和倾斜角均较术前显著改善,差异有统计学意义(P<0.05);两组间比较差异均无统计学意义(P>0.05)。结论应用缝合锚钉固定或经骨缝合术完成MPFL双束重建均可恢复髌骨稳定性,二者术后近期疗效无明显差异。

Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament(MPFL)double bundle reconstruction.Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed.All of them were treated with MPFL double bundle reconstruction,and divided into study group(39 cases,using new transosseous suture technique)and control group(36 cases,using traditional suture anchor fixation)depending on the intraoperative fixation technique.There was no significant difference in gender,age,body mass index,affected knee side,preoperative tibial tuberosity-trochlear groove distance,Insall-Salvati ratio,knee range of motion,Kujala score,International Knee Documentation Committee(IKDC)score,congruence angle,and tilt angle between the two groups(P>0.05).The operation time,intraoperative blood loss,hospital stay,and postoperative complications were recorded and compared between the two groups.Kujala score,IKDC score,and knee range of motion were used to evaluate the functional improvement of patients before and after operation.The congruence angle and tilt angle were measured on X-ray films.Results There was no significant difference in operation time,intraoperative blood loss,and hospital stay between the two groups(P>0.05).Patients in both groups were followed up 24-36 months,with an average of 29.4 months.There was no complication such as incision infection,fat liquefaction,patellar redislocation,and prepatellar pain during follow-up.At last follow-up,the Kujala score,IKDC score,knee range of motion,congruence angle,and tilt angle of two groups significantly improved when compared with those before operation(P<0.05),while there was no significant difference between the two groups(P>0.05).Conclusion The application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability,and there is no significant difference in the short-term effectiveness between them.