关节镜辅助下髌股韧带重建治疗无骨性结构异常的复发性髌骨脱位的临床观察

The treatment of recurrent dislocation patella of boneless textural anomaly using patellofemoral ligament's reconstruction under arthroscopy

目的探讨关节镜下半腱肌肌腱解剖重建内侧髌股韧带治疗无骨性结构异常的复发性髌骨脱位的效果。方法复发性髌骨脱位患者76例,取同侧自体半腱肌肌腱重建髌股韧带,髌骨侧采用髌骨骨槽加双锚钉固定,于关节内整髌骨轨迹匹配,股骨侧采用界面螺钉固定。如外侧支持带挛缩给予松解外侧支持带,所有入选病例均排除骨性结构异常的患者。所有患者均得到随访,随访时间4～36个月,平均12个月。疗效评价采用国际膝关节评分委员会(IKDC)膝关节功能主观评分、Lysholm膝关节功能评分、Tegner膝关节运动评分及影像学评价。结果术后随访均无髌骨再次脱位及髌骨骨折,恐惧试验均阴性。末次随访IKDC膝关节功能评分(94. 30±4. 26)分,Lysholm膝关节功能评分(94. 30±5. 32)分,Tegner膝关节运动评分(6. 32±0. 72)分,影像学髌股适合角(5. 72±1. 20)°、髌骨外移率(0. 50±0. 12),与术前比较差异有统计学意义(P <0. 05)。结论关节镜辅助下髌股韧带重建治疗无骨性结构异常的复发性髌骨脱位疗效可靠。

Objective To evaluate the clinical effects of the treatment of recurrent dislocation patella of boneless textural anomaly using the semitendinosus lateral patellofemoral ligament’s anatomy and reconstruction under arthroscopy.Method 76 patients with recurrent dislocation patella were received and cured.The autologous semitendinosus to reconstruct patellofemoral ligament was selected.The patellae’s bone crib and double bone anchor fixed up the patella side to adjust patella locus for phase match underneath the joint,and the thighbone side was used the interference screw to fix.The lateral retinaculum was released,when confronting lateral retinaculum contracture.Among all the selected patients,those with abnormality of bone structure have been excluded.All cases were followed up for four days to 36 months.The average was 12 months.Clinical evaluation of curative effect adopted IKDC(International Knee Documentation Committee),Lysholm knee scoring scale,Tegner activity scale and Imaging evaluation.Results Patients were followed-up after operation.Their recurrent dislocation of patella and fracture of patella never happened again.Fear test was negative.The IKDC’s Clinical evaluation of curative effect(94.30±4.26),Lysholm knee scoring scale(94.30±5.32),Tegner activity scale(6.32±0.72),the congruence angle and lateral shift were 5.72°±1.20°and 0.50±0.12.Conclusion The treatment of recurrent dislocation patella of boneless textural anomaly using patellofemoral ligament’s reconstruction under arthroscopy is reliable.