锚钉辅助伸膝装置联合重排术治疗复发性髌骨脱位的中期疗效

Mid-term effectiveness analysis of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation

目的 探讨锚钉辅助伸膝装置联合重排术治疗复发性髌骨脱位的中期疗效。方法 回顾分析2017年8月—2019年5月采用锚钉辅助伸膝装置联合重排术治疗并获3年以上随访的21例复发性髌骨脱位患者临床资料。男8例,女13例;年龄13~26岁,平均19.4岁。21例均有明确反复髌骨脱位史(2~5次,中位数3次);病程1~16年,平均5年。术前Lysholm评分为(67.5±6.3)分,Kujula评分为(64.1±7.0)分。MRI检查排除半月板、前后交叉韧带、内外侧副韧带损伤;CT检查示髌股关节胫骨结节-股骨滑车间距为2.05~2.56 cm,平均2.16 cm;X线片检查示下肢力线无明显异常。采用术前及术后3年Lysholm评分、Kujula评分,以及术后3年Insall疗效评定标准评价疗效。结果 术后患者切口均Ⅰ期愈合,无下肢深静脉血栓形成、切口感染、神经损伤等手术并发症发生。21例患者均获随访,随访时间3.0~3.5年,平均3.2年。术后3年膝关节正侧位X线片示髌骨位置正常,髌骨轴位X线片(30°、60°、90°)示髌股关节对合关系良好。随访期间无锚钉脱落、断裂,无明显假关节形成,未成年患者无骨骺损伤表现。术后3年Lysholm评分为(91.5±7.1)分,Kujula评分为(88.1±7.6)分,均较术前显著改善(t=11.57,P=0.00;t=12.78,P=0.00)。根据Insall疗效评定标准,获优12例、良4例、可4例、差1例,优良率76.2%。结论 采用锚钉辅助伸膝装置联合重排术治疗复发性髌骨脱位,操作简便,中期疗效满意,并发症少,远期疗效有待进一步随访。

Objective To explore the mid-term effectiveness of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation. Methods Between August 2017 and May 2019, 21 patients with recurrent patella dislocation underwent combined knee extensor mechanism realigament with bone anchor and followed up more than 3 years. There were 8 males and 13 females with an average age of 19.4 years(range, 13-26 years). All 21patients had a history of recurrent patellar dislocation for 2-5 times(median, 3 times), and the disease duration was 1-16years(mean, 5 years). The preoperative Lysholm score was 67.5±6.3 and the Kujula score was 64.1±7.0. The defect of meniscus, anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments were excluded by MRI examination;CT examination showed that the tibial tuberosity-trochlear groove distance was 2.05-2.56 cm, with an average of 2.16 cm;X-ray examination showed that lower limb force line was abnormal. The effectiveness were evaluated by Lysholm score and Kujula score before operation and at 3 years after operation, and Insall evaluation standard at3 years after operation. Results All the incisions healed by first intention, and there was no surgical complication such as lower extremity deep vein thrombosis, incision infection, and nerve injury. All 21 patients were followed up 3.0-3.5 years,with an average of 3.2 years. Anteroposterior and lateral X-ray films of the knee joint at 3 years after operation showed that the position of the patella was normal, and the axial X-ray films of the patella(30°, 60°, 90°) showed that the patellofemoral joint had a good relationship. During the follow-up, there was no anchor drop or fracture, no obvious pseudarthrosis formation, and no epiphyseal injury in the minor patients. The Lysholm score was 91.5±7.1 and the Kujula score was88.1±7.6 at 3 years after operation, which were significantly improved when compared with those before operation(t=11.57, P=0.00;t=12.78, P=0.00). According to the Insall evaluation criteria, 12 cases were excellent, 4 cases were good,4 cases were fair, and 1 case was poor, with an excellent and good rate of 76.2%. Conclusion Combined knee extensor mechanism realignment with bone anchor is a simple and reliable way to treat the recurrent patella dislocation, with a satisfactory mid-term effectiveness and less complications;however, its long-term effectiveness needs further follow-up.