急性髌骨脱位合并髌骨软骨骨折两种修复方式的疗效比较

The Curative Efficacy Comparison of Two Types of Repair Acute Patellar Dislocation and Patella Cartilage Fractures(Peel off Damage)

目的:比较髌骨内侧韧带紧缩缝合与内侧髌股韧带(Medial Patellofemoral Ligament,MPFL)重建治疗急性髌骨脱位合并髌骨软骨骨折(脱落损伤)的临床疗效。方法:回顾性分析采用髌骨内侧韧带紧缩缝合和内侧髌股韧带重建治疗急性髌骨脱位合并髌骨软骨骨折的40例患者的临床资料。依据术前医患交流及选择,21例采用髌骨内侧韧带紧缩缝合(对照组),19例采用内侧髌股韧带重建(常规组),同时两组髌骨软骨骨折都采用相同缝线经骨固定方式,比较两组相关围手术期指征、随访功能情况。结果:两组患者均完成手术且术中术后均无并发症发生。在近期观察(围手术期)指标方面,对照组手术时间和术中透视次数均显著少于常规组,差异有统计学意义(P<0.05)。而在远期观察(随访功能)指标方面,在随访过程中两组均未再次发生髌骨脱位及髌骨软骨骨折块的脱落及二次骨折。在完全恢复负重活动时间方面,对照组略显优势,差异有统计学意义(P<0.05)。但术后12个月两组组内膝关节Lysholm评分和Kujala评分均显著增加,差异有统计学意义(P<0.05),组内视觉模拟量表(VAS)评分显著减少(P<0.05);但在随访相对应时间点,两组间的统计指标整体差异均无统计学意义(P>0.05)。结论:髌骨内侧韧带紧缩缝合+髌骨软骨骨折复位内固定术与内侧髌股韧带重建+髌骨软骨骨折复位内固定术治疗急性髌骨脱位合并脱落损伤(髌骨软骨骨折)均取得满意临床疗效,但在减少手术时间、术中透视次数及患肢恢复负重活动时间方面,采取髌骨内侧韧带紧缩缝合+髌骨软骨骨折复位内固定术具有明显优势。

Objective:To compare tight patella medial ligament suture and the medial patellofemoral ligament(MPFL)reconstruction on treatment of acute patellar dislocation of patella cartilage fractures(peel off injury)clinical curative efficacy.Methods:40patients with acute patellar dislocation combined with patellar cartilage fracture(peel off injury)treated with medial patellofemoral ligament tightening suture and MPFL reconstruction were analyzed retrospectively.On the basis of preoperative doctor-patient communication and choice,21cases by tightening the medial patellar ligament suture(control group),19patients with the MPFL reconstruction(normal group),at the same time two groups of fracture of patella cartilage is made of the same stitches after bone fixed way.Compared two groups related to perioperative indications,follow-up function.Results:Two groups of patients after surgery and intraoperative no complications occurred.On the recent observation(perioperative)indicators:the control group(tight patella medial ligament suture)in operation time and intraoperative fluoroscopy times were significantly less than the conventional group(MPFL reconstruction)(P<0.05).And observed in the long term follow-up(function)indicators,two groups have been followed up,two groups did not happen again in the process of follow-up patellar dislocation and fracture of patella cartilage block off and secondary fractures.In fully recover time of activity in the control group(tightening the medial patellar ligament suture)slightly advantage(P<0.05).But after one year,knee joint Lysholm scores and Kujala scores of two groups were significantly increased(P<0.05),visual analogue scale(VAS)score significantly reduced(P<0.05),relatively should point at follow-up,statistical indicators of the overall difference between the two groups had no statistical significance(P>0.05).Conclusion:The medial patellar ligament suture with reduction and internal fixation of fracture of patella cartilage and tightening the MPFL reconstruction with patellar cartilage fracture reduction and internal fixation treatment of acute patellar dislocation combined fracture of patella cartilage has achieved satisfactory clinical efficacy,but in the overall time to reduce the operation time,intraoperative fluoroscopy times and limb weight-bearing activities take tight patella medial ligament suture with reduction and internal fixation of fracture of patella cartilage has obvious advantages.