单半隧道、双半弯形隧道和缝线锚钉固定重建内侧髌股韧带治疗髌骨脱位的疗效比较

Comparison of effect of medial patellofemoral ligament reconstruction using single half tunnel,double half curved tunnel and suture anchor fixation for patients with patellar dislocation

目的比较单半隧道、双半弯形隧道和缝线锚钉固定重建内侧髌股韧带(MPFL)治疗髌骨脱位的疗效。方法采用回顾性队列研究分析2018年6月至2021年2月兰州大学第二医院收治的58例髌骨脱位患者的临床资料,其中男22例,女36例;年龄12~34岁[(19.6±5.5)岁]。20例采用关节镜下单半隧道固定重建MPFL(单半隧道组),18例采用关节镜下双半弯形隧道固定重建MPFL(双半弯形隧道组),20例采用关节镜下缝线锚钉固定重建MPFL(缝线锚钉组)。比较三组术前、术后3个月及末次随访时Lysholm评分、国际膝关节文献委员会(IKDC)评分、Tegner活动评分。比较三组术后3个月和末次随访时膝关节活动度。观察术后并发症发生情况。结果患者均获随访9~39个月[(26.5±9.1)个月]。术后3个月单半隧道组、双半弯形隧道组和缝线锚钉组Lysholm评分分别为(78.4±12.0)分、(88.7±7.5)分、(81.1±9.8)分,末次随访时分别为(80.4±14.2)分、(90.9±9.0)分、(83.3±9.1)分,较术前明显升高(P均<0.01);术后3个月及末次随访时双半弯形隧道组Lysholm评分显著高于其他两组(P均<0.05),其余两组间差异无统计学意义(P均>0.05)。术后3个月单半隧道组、双半弯形隧道组和缝线锚钉组IKDC评分分别为(76.7±12.2)分、(78.4±8.9)分、(81.0±8.1)分,末次随访时分别为(77.6±15.8)分、(83.2±7.8)分、(82.4±12.4)分,较术前明显升高(P均<0.01);三组间差异无统计学意义(P均>0.05)。术后3个月单半隧道组、双半弯形隧道组和缝线锚钉组Tegner评分分别为(4.0±1.2)分、(5.4±1.7)分、(5.3±1.7)分,末次随访时分别为(4.1±1.4)分、(5.8±1.8)分、(5.3±2.2)分,较术前明显升高(P均<0.01);术后3个月及末次随访时单半隧道组Tegner评分显著低于其他两组(P均<0.05),其余组间差异无统计学意义(P均>0.05)。末次随访时单半隧道组、双半弯形隧道组和缝线锚钉组膝关节活动度分别为(122.3±6.4)°、(121.7±7.1)°、(123.3±5.7)°,较术后3个月的(117.3±8.0)°、(115.3±7.9)°、(116.8±8.3)°明显恢复(P均<0.05);三组间差异无统计学意义(P均>0.05)。单半隧道组术后并发症发生率为10.0%(2/20),双半弯形隧道组为5.6%(1/18),缝线锚钉组为25.0%(5/20)(P>0.05)。结论单半隧道、双半弯形隧道和缝线锚钉固定重建MPFL治疗髌骨脱位均可改善膝关节活动度,但双半弯形隧道固定后膝关节功能恢复更好。

Objective To compare the efficacy of medial patellofemoral ligament(MPFL)reconstruction using single half tunnel,double half curved tunnel and suture anchor fixation in the treatment of patellar dislocation.Methods A retrospective cohort study was used to analyze the clinical data of 58 patients with patellar dislocation treated in Second Hospital of Lanzhou University from June 2018 to February 2021,including 22 males and 36 females,aged 12‑34 years[(19.6±5.5)years].MPFL reconstruction was performed arthroscopically using single half tunnel fixation in 20 patients(single half tunnel group),double half curved tunnel fixation in 18(double half curved tunnel group)and suture anchor fixation in 20(suture anchor group).The Lysholm score,International Knee Documentation Committee(IKDC)score and Tegner activity score were compared among groups before operation,at 3 months after operation and at the last follow‑up.The knee range of motion was compared among the three groups at 3 months after operation and at the last follow‑up.The postoperative complications of the three groups were observed at the last follow‑up.Results All patients were followed up for 9‑39 months[(26.5±9.1)months].In single half tunnel group,double half curved tunnel group and suture anchor group,the Lysholm score was(78.4±12.0)points,(88.7±7.5)points and(81.1±9.8)points at 3 months after operation,and(80.4±14.2)points,(90.9±9.0)points and(83.3±9.1)points at the last follow‑up.The postoperative Lysholm score in all groups was significantly increased from that preoperatively(all P<0.01).The Lysholm score in double half curved tunnel group was significantly higher than that in other two groups at 3 months after operation and at last follow‑up(all P<0.05),but there was no significant difference between other groups(all P>0.05).In single half tunnel group,double half curved tunnel group and suture anchor group,the IKDC score was(76.7±12.2)points,(78.4±8.9)points and(81.0±8.1)points at 3 months after operation,and(77.6±15.8)points,(83.2±7.8)points and(82.4±12.4)points at the last follow‑up.The postoperative IKDC score in all groups was significantly increased from that preoperatively(all P<0.01),but there was no significant difference among the three groups(all P>0.05).In single half tunnel group,double half curved tunnel group and suture anchor group,the Tegner score was(4.0±1.2)points,(5.4±1.7)points and(5.3±1.7)points at 3 months after operation,and(4.1±1.4)points,(5.8±1.8)points and(5.3±2.2)points at the last follow‑up.The postoperative Tegner score in all groups was significantly improved from that preoperatively(all P<0.01).The Tegner score in single half tunnel group was significantly lower than that in other two groups at 3 months after operation and at last follow‑up(all P<0.05),but there was no significant difference between other groups(all P>0.05).In single half tunnel group,double half curved tunnel group and suture anchor group,the knee range of motion was(122.3±6.4)°,(121.7±7.1)°and(123.3±5.7)°at the last follow‑up,which were significantly increased from(117.3±8.0)°,(115.3±7.9)°and(116.8±8.3)°at 3 months after operation(all P<0.05),with no significant difference among the three groups(all P>0.05).The postoperative complication rate was 10.0%(2/20)in single half tunnel group,5.6%(1/18)in double half curved tunnel group,and 25.0%(5/20)in suture anchor group(P>0.05).Conclusions For patellar dislocation,MPFL reconstruction using single half tunnel,double half curve tunnel and suture anchor fixation have achieved satisfactory improvement of knee range of motion,but knee functional recovery is much better after double half curved tunnel fixation.