关节镜辅助下内侧髌股韧带双束重建联合外侧支持带松解治疗青少年复发性髌骨脱位的临床效果

Clinical Effect of Arthroscopy-assisted Double-bundle Medial Patellofemoral Ligament Reconstruction Combined with Lateral Retinaculum Release in the Treatment of Recurrent Patellar Dislocation in Adolescents

目的探讨采用关节镜辅助下内侧髌股韧带(Medial Patellofemoral Ligament MPFL)双束解剖重建联合外侧支持带松解术式治疗青少年复发性髌骨脱位的临床疗效。方法收集2019年1月至2020年12月就诊于我院复发性髌骨脱位患者30例。所有患者均采用关节镜辅助下自体半腱肌双束解剖重建MPFL联合外侧支持带松解治疗,术后给予相同的康复治疗方案。分别比较术前、术后膝关节功能评分:Kujala评分、Lysholm评分、Tegner评分,影像学指标采用外侧髌股角(LPA)、髌股适合角(CA)、髌骨倾斜角(PTA)、髌骨外移度(LPT)评估。结果纳入的所有患者手术均顺利进行,并获得随访,随访时间12~20个月,平均(15.10±2.54)个月。术后膝关节影像学检查提示髌骨位置良好,髌股关节解剖关系对位正常,髌骨恐惧试验阴性,无复发性脱位或半脱位。术前Kujala评分、Lysholm评分、Tegner评分分别为(52.80±2.47)分、(56.07±3.37)分、(3.30±0.84)分,术后Kujala评分、Lysholm评分、Tegner评分分别为(88.67±2.63)分、(90.80±3.09)分、(7.20±0.93)分,均较术前升高,差异有统计学意义(P<0.001);术前LPA、CA、PTA及LPT分别为(16.33±1.53)°、(22.42±1.96)°、(21.77±2.55)°、(42.36±3.25)mm,术后LPA、CA、PTA及LPT分别为(10.20±1.04)°、(10.30±1.48)°、(9.31±2.35)°、(9.58±2.18)mm,术后较术前均减小,差异有统计学意义(P<0.001)。结论关节镜辅助下内侧髌股韧带双束重建联合外侧支持带松解术能够有效治疗青少年复发性髌骨脱位,纠正髌骨运动轨迹,改善膝关节功能,是一种安全、有效的手术方法。

Objective To explore the clinical effects of arthroscopic-assisted medial patellofemoral ligament(MPFL)double-bundle anatomical reconstruction combined with lateral retinaculum release in the treatment of recurrent patellar dislocation in adolescents.Methods A collection of 30 patients with recurrent patellar dislocation in our hospital from January 2019 to December 2020,including 9 males and 21 females.Left knee 12 cases,right knee 18 cases,The age ranged from 13 to 17 years,with an average of(14.80±1.27)years.All patients were treated with autogenous semitendinosus double-bundle anatomical reconstruction MPFL combined with lateral retinaculum release under the assistance of arthroscopy,than the same rehabilitation treatment plan was given after the operation.Results All the included patiens performed smoothly and were followed up.The follow-up time was 12-20 months,with an average of(15.10±2.54)months.The postoperative imaging examination of the knee joint showed that the patella was in good position,the anatomical relationship of the patellofemoral joint was normal,the patella fear test was negative,and there was no recurrent dislocation or subluxation.The preoperative Kujala score,Lysholm score,and Tegner score were(52.80±2.47),(56.07±3.37),and(3.30±0.84)points,respectively.Postoperative Kujala score,Lysholm score,and Tegner score were(88.67±2.63),respectively Points,(90.80±3.09)points,(7.20±0.93)points,all higher than those before surgery,the difference was statistically significant(P<0.001);Preoperative LPA,CA,PTA and LPT were(16.33±1.53)°,(22.42±1.96)°,(21.77±2.55)°,(42.36±3.25)mm,respectively.Postoperative LPA,CA,PTA and LPT were(10.20±1.04)°,(10.30±1.48)°,(9.31±2.35)°,(9.58±2.18)mm,respectively,which were significantly lower than those before surgery(P<0.001).Conclusion Arthroscopy-assisted medial patellofemoral ligament reconstruction combined with lateral retinacular release is a safe and effective surgical method for the treatment of recurrent patellar dislocation in adolescents,correction of patellar motion trajectory and improvement of knee function.