内侧髌韧带修复或重建对青少年急性髌骨脱位的疗效观察

Clinical analysis of medial patellofemoral ligament repair or reconstruction for acute patellar dislocation in adolescents

目的探讨内侧髌股韧带(MPFL)修复或重建两种方法治疗青少年急性髌骨脱位的初期临床效果。方法回顾性分析2019年8月至2022年8月于张家口市第二医院小儿骨科行手术治疗的符合纳入与排除标准的急性髌骨脱位23例(23膝)临床资料,其中男10例,女13例;年龄11~14(13.6±1.6)岁。MPFL重建组(13例)采用大收肌腱单束重建MPFL;修复组(10例)采用聚醚醚酮(PEEK)锚钉修复MPFL髌骨侧止点。比较两组Kujala功能评分、膝关节活动度、主观满意度、手术并发症等指标,综合评价手术方法对急性髌骨脱位治疗效果。结果MPFL重建组1例失访;其余22例患者获得随访,术后获得平均随访时间为30.8(13~50)个月;所有随访患者均无髌骨不稳及髌骨脱位发生。组内Kujala功能评分显示术后膝关节结构和功能均获得显著改善(P<0.01)。膝关节活动范围术后6个月恢复正常;膝关节活动度组内比较差异有统计学意义(P<0.01)。修复组主观满意度指数为93.5%±4.8%;重建组为90.1%±7.4%。重建组5例(42%)大腿内侧取大收肌腱处手术切口愈合不良;2例二次清创手术后愈合;3例换药后愈合。结论MPFL修复和重建治疗青少年急性髌骨脱位初期临床效果满意;MPFL重建能够提供更强的稳定性;但两种方法均需结合髌骨脱位危险因素分析,同时行髌骨稳定手术。

Objective To compare the initial clinical effect of medial patellofemoral ligament(MPFL)repair and reconstruction in the treatment of acute patellar dislocation in adolescents.Methods The clinical data of 23 cases(23 knees)of acute patellar dislocation treated in Department of Pediatric Orthopedic Surgery of Zhangjiakou Second Hospital from August 2019 to August 2022 were retrospectively analyzed.There were 7 males and 10 females,aged 11-14(13.6±1.6)years.MPFL reconstruction group(13 cases)treated by double fascicular reconstruction MPFL of great adductor tendon.Repair group(10 cases)treated by MPFL patellar lateral insertion with PEEK anchor.Kujala function score,knee motion,supervisor satisfaction and surgical complications were compared between the two groups to evaluate the effect of this surgical method on acute patellar dislocation.Results In the MPFL reconstruction group,1 patient was lost to follow-up;the other 22 patients were followed up.The mean follow-up time was 30.8(13-50)months.None of the follow-up patients had patellar instability or patellar dislocation.Kujala functional score showed that the structure and function of knee joint were significantly improved after surgery,with statistical significance(P<0.01).The range of motion of the knee joint returned to normal in 6 months after operation;there was statistical significance in the range of motion of the knee joint within the groups(P<0.01).The subjective satisfaction index was 93.5%±4.8%in repair group,and 90.1%±7.4%in reconstruction group.In the reconstruction group,there were 5 cases(42%)with poor healing of incision at the large adductor tendon of the inner thigh,2 cases with healing after secondary detoxication,and 3 cases with healing after dressing change.Conclusion The initial clinical effect of MPFL repair and reconstruction in the treatment of acute patellar dislocation in adolescents is satisfactory.MPFL reconstruction can provide stronger stability.Both repair and reconstruction need a comprehensive and detailed analysis of the risk factors of patellar dislocation.Patellar stabilization surgery is worthy of promotion.