复发性髌骨脱位胫骨结节截骨移位内侧髌股韧带重建

Tibial tubercle osteotomy and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

[目的]探讨胫骨结节截骨移位术联合双隧道等长重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗复发性髌骨脱位的临床疗效。[方法]回顾性分析2017年5月—2022年5月本院收治的20例复发性髌骨脱位的患者资料,均行双隧道等长重建MPFL联合胫骨结节截骨移位。评估临床及影像结果。[结果]患者均顺利完成手术,手术时间(65.3±6.7)min,随访时间平均(12.2±0.7)个月,与术前相比,术后12个月患者Lysholm评分[(53.7±9.9),(86.5±6.0),P<0.001]、Kujala评分[(55.5±6.3),(83.7±7.9),P<0.001]、IKDC评分[(54.6±8.7),(86.7±6.9),P<0.001]均显著增加。至末次随访时,所有患者均无再脱位发生。影像方面,与术前相比,术后12个月,患者髌骨适合角(patellofemoral congruence angle,PCA)[(28.2±4.4)°,(13.3±2.6)°,P<0.001]、髌骨倾斜角(patella title angle,PTA)[(23.1±4.8)°,(8.9±2.9)°,P<0.001]、胫骨结节-股骨滑车间沟距离(tibial tubercletrochlear groove distance,TT-TG)[(22.1±1.74)mm,(11.9±1.9)mm,P<0.001]、股四头肌角(quadricep angle,Q角)[(23.1±2.4)°,(15.1±2.6)°,P<0.001]均显著减小,但髌股关节软骨厚度无明显变化(P>0.05)。[结论]双隧道等长重建MPFL联合胫骨结节截骨移位术治疗复发性髌骨脱位的临床疗效显著。

[Objective]To investigate the clinical efficacy of tibial tuberosity osteotomy combined with double-tunnel isometric recon⁃struction of medial patellofemoral ligament(MPFL)in the treatment of recurrent patellar dislocation.[Methods]A retrospective study was conducted on 20 patients who received surgical treatment for recurrent patellar dislocation in our hospital from May 2017 to May 2022.All of them underwent double-tunnel isometric reconstruction MPFL combined with tibial tuberosity osteotomy.The clinical and imaging data were evaluated.[Results]All the patients had operation performed successfully with operation time of(65.3±6.7)min,and were followed up for(12.2±0.7)months.Compared with those before operation,the Lysholm score[(53.7±9.9),(86.5±6.0),P<0.001],Kujala score[(55.5±6.3),(83.7±7.9),P<0.001]and IKDC scores[(54.6±8.7),(86.7±6.9),P<0.001]were significantly increased 12 months postoperatively.No further dislocation occurred in anyone of them utill the last follow-up.Radiographically,the patellofemoral congruence angle(PCA)[(28.2±4.4)°,(13.3±2.6)°,P<0.001],patella title angle(PTA)[(23.1±4.8)°,(8.9±2.9)°,P<0.001],tibial tubercle-trochlear groove distance(TT-TG)[(22.1±1.74)mm,(11.9±1.9)mm,P<0.001]and quadricep angle(Q Angle)[(23.1±2.4)°,(15.1±2.6)°,P<0.001]decreased significantly 12 months after operation compared with those preoperatively,but the patellofemoral cartilage thickness remained unchanged(P>0.05).[Conclusion]The tibial tuberosity osteotomy combined with double-tunnel isometric reconstruction of MPFL is an effective treatment for recurrent patel⁃lar dislocation.