滑车击打成形联合髌骨远近端重排治疗固定性髌骨外脱位的临床研究

The Clinical Research on the Treatment of Fixed External Dislocation of Patella by Femoral Pulley Blow Shaping Combined with Distal and Distal Rearrangement of Patella

目的:探讨股骨滑车击打成形联合髌骨远近端重排(外侧髌股韧带松解、内侧髌股韧带重建、胫骨结节内移)治疗固定性髌骨外脱位伴严重股骨滑车发育不良的临床疗效。方法:回顾性分析2019年1月至2022年1月诊断为固定性髌骨外脱位伴严重股骨滑车发育不良13例患者的临床资料,其中男6例,女7例;平均年龄为(22.9±1.2)岁。均进行了股骨滑车击打成形联合髌骨远近端重排治疗,通过比较手术前后X线、CT测量股骨滑车沟角(SA)、适合角(CA)、髌骨侧方移位度(LD)、胫骨结节与股骨滑车沟距离(TT-TG)、Caton-Deschamps指数(评估高低位髌骨)、Lysholm膝关节功能评分与Kujala髌股关节不稳症状评分来评估其临床疗效。结果:本组患者均获得随访,随访时间为1~3年,平均为(1.6±0.2)年,术后伤口均Ⅰ期愈合,未发生感染、血管神经损伤等并发症,术后患者生活质量明显改善,未再次出现患肢髌骨脱位;术后1年MRI未见明显股骨滑车软骨损伤、脱落、坏死等现象,术后1年X线、CT测量股骨滑车沟角、适合角、髌骨侧方移位度、胫骨结节与股骨滑车沟距离及Caton-Deschamps指数均恢复到正常范围,与术前比较明显降低,差异有统计学意义(P<0.05)。术后1年患肢功能Lysholm膝关节功能评分从术前的(54.60±5.22)分增加到(82.60±2.70)分,Kujala髌股关节不稳症状评分从术前的(54.20±8.04)分增加到术后的(81.60±3.97)分,差异有统计学意义(P<0.05)。结论:针对固定性髌骨外脱位伴严重滑车发育不良的患者,采用股骨滑车击打成形可以重建股骨滑车沟,手术操作简单;联合髌骨远近端重排,可纠正髌股关节的运动轨迹,改善膝关节功能,中短期临床疗效良好,值得进一步推广应用。

Objective:To investigate the clinical efficacy of the treatment of fixed external dislocation of patella with severe femoral trochlear dysplasia by femoral pulley blow shaping combined with proximal and distal rearrangement of patella(lateral patellofemoral ligament release,medial patellofemoral ligament reconstruction,tibial tuberosity inward).Methods:The clinical data of 13 patients diagnosed as fixed external patellar dislocation with severe femoral trochlear dysplasia from January 2019 to January 2022 were retrospectively analyzed.The patients in this group were 6 males and 7 females,with an average age of(22.9±1.2) years old,all of the patients had received the treatment of femoral pulley blow shaping combined with proximal and distal rearrangement of patella.The measurement of femoral trochlear angle(SA),fit angle(CA),lateral displacement of patella(LD),distance between tibial nodule and trochlear groove of femur(TT-TG),Caton-Deschamps index by X-ray and CT were compared before and after surgery.The Lysholm knee function scores and Kujala patellofemoral instability symptom scores were compared before and after surgery.Results:All patients in this group were followed up by 1■3 years,mean(1.6±0.2) years.The postoperative wounds were well-healed,without infection,vascular and nerve injury and other complications.The postoperative quality of life of these patients were significantly improved,and patellar dislocation of the affected limbs did not occur again.MRI showed no obvious femoral trochlear cartilage injury,shedding and necrosis 1 year after surgery.The measurements of SA angle,CA angle,LD,TT-TG and Caton-Deschamps index by X-ray and CT 1 year after surgery had returned to the normal range,which were significantly lower than that before surgery,and the differences were statistically significant(P<0.05).The Lysholm scores of knee function increased from(54.60±5.22) points before surgery to(82.60±2.70) points 1 year after surgery,and the Kujala symptom scores of patellofemoral instability increased from(54.20±8.04) points before surgery to(81.60±3.97) points 1 year after surgery,and the differences were statistically significant(P<0.05).Conclusion:For patients with fixed external patellar dislocation with severe femoral trochlear dysplasia,the femoral chlea groove can be effectively reconstructed by femoral pulley blow shaping,and the operation is simple and no special tools are needed.Combined with proximal and distal rearrangement of patella,it can effectively correct the motion trajectory of patellofemoral joint and improve the function of knee joint.It has good clinical efficacy in the short and medium term and is worthy of further study.