伸膝装置联合重排术治疗复发性髌骨脱位术后运动学分析

Kinematics Analysis of Knee Extensor Apparatus Rearrangement for Recurrent Patellar Dislocation

目的对比研究伸膝装置联合重排术治疗复发性髌骨脱位的手术前后患侧膝关节运动学变化情况。方法选取自2016年1月至2021年10月昆明医科大学第一附属医院确诊为复发性髌骨脱位并行锚钉辅助伸膝装置联合重排术的患者共45例45膝为研究对象,同时收集45例正常人膝关节运动学数据。手术组45例,其中男21例,女24例;年龄12~16岁,平均(13.00±1.25)岁;右膝20例,左膝25例。健康对照组45例,其中男23例,女22例;年龄12~16岁,平均(14.00±0.75)岁;右膝22例,左膝23例。记录术前和术后12个月患膝膝关节运动学数据进行对比分析,并将术后12个月患膝与正常人膝关节运动时6个自由度活动范围及步数、步长进行对比分析。结果(1)术后12个月患者的最大伸膝角度较术前减小(P<0.05),平均步数减小(P<0.05),平均步长变长(P<0.05)。(2)术后12个月患者膝关节内外翻角、内外旋角、屈伸角、前后位移、上下位移、内外位移及步数、步长与正常人差异无统计学意义(P>0.05)。结论(1)伸膝装置联合重排术治疗复发性髌骨脱位可获得满意的早期膝关节功能。(2)膝关节运动学分析可更加客观的评估膝关节手术前后动态情况,对临床疗效评估具有一定的指导意义。

Objective To compare the kinematic changes of knee joint before and after knee extensor apparatus rearrangement in the treatment of recurrent patellar dislocation.Methods 45 patients(45 knees)with recurrent patellar dislocation and anchor-assisted extensor apparatus of the knee rearrangement were selected from the First Affiliated Hospital of Kunming Medical University from January 2016 to October 2021.The knee joint kinematics data of 45 normal subjects were collected,including 45 cases in the operation group.There were 21 males and 24 females,aged from 12 to 16 years old,with an average age of(13.0±1.25)years old.There were 20 cases in the right knee and 25 cases in the left knee.The control group had 45 healthy volunteers,including 23 males and 22 females,aged from 12 to 16 years old,with an average age of(14.0±0.75)years old.There were 22 cases of the right knee and 23 cases of the left knee.The kinematic data of the affected knee joint were recorded before and 12 months after operation,the range of motion,step number and step length of 6 degrees of freedom were compared between the affected knee joint and the normal knee joint 12 months after operation.Results(1)At 12 months after operation,the maximum knee extension angle decreased(P<0.05),the average step decreased(P<0.05),and the average step length changed(P<0.05).(2)12 months after operation,there was no difference in knee joint valgus angle,internal and external rotation angle,flexion and extension angle,anterior and posterior displacement,upper and lower displacement,internal and external displacement,step number and step length between patients and normal subjects(P>0.05).Conclusion(1)Satisfactory early knee function can be obtained in the treatment of recurrent patellar dislocation with rearrangement of extensor apparatus of the knee.(2)Knee joint kinematics analysis can more objectively evaluate the dynamic situation of knee joint before and after operation,which is helpful to evaluate the curative effect.