“双滑轮法”取腱编织重建髌股内侧副韧带修复青少年急性髌骨脱位

发布时间：2018-05-24 05:48

本文选题：髌骨 + 髌股骨关节　；参考：《中国组织工程研究》2017年20期

【摘要】：背景:目前针对青少年急性髌骨脱位研究较多,存在较大的争议,尚无统一的最佳治疗决策。目的:总结应用"双滑轮法"重建髌股内侧副韧带治疗青少年急性髌骨脱位临床疗效。方法:髌骨急性脱位30例,均由同一组医生行采用"双滑轮法"重建髌股内侧副韧带治疗,使用关节镜磨头在髌骨内上缘髌骨中点及髌骨中上1/3沿髌骨长轴做小的骨槽,以容纳肌腱为准。在骨槽内髌骨中点和髌骨中上1/3两点平行于髌骨关节面打入2枚带双线5.0锚钉,锚钉上双线分别各打1个结,另外2根加强缝合于周围软组织上,肌腱缝合为一股端,形成"双滑车"结构。于股骨内上髁及收肌结节处,切开长纵向小切口,显露内上髁及收肌结节,于两切口之间打通深筋膜隧道,将肌腱编织端拉过隧道,建立股骨端隧道,将肌腱沿股骨隧道牵拉向外侧,拉紧肌腱合适松紧度后界面螺钉挤压固定。随访10个月以上,进行韧带重建前后髌骨相关参数及膝关节功能参数比较。结果与结论:(1)患者合并关节内软骨损伤12例,半月板损伤4例。(2)患者末次随访时髌骨倾斜角、Q角、髌骨外移值均小于韧带重建前;(3)患者末次随访膝关节功能Lysholm评分和IKDC评分均高于重建前;(4)平均手术时间(90.0±10.5)min。(5)韧带重建后出现1例膝关节活动0°-30°患者;1例因摔跤致髌骨骨折,二期进行髌骨骨折切开复位内固定;未发现髌骨脱位,未出现髌骨恐惧试验阳性,未出现感染、切口愈合不良。(6)结果提示:"双滑轮法"手术简单、创伤小、符合髌骨解剖结构的稳定性、具有髌骨运动轨迹可视性、韧带重建后患者恢复快、疗效好。若单纯应用效果不佳时,可二期再行截骨处理等优点,是急性髌骨脱位的很好手术选择之一。
[Abstract]:Background: there are many researches on acute patellar dislocation in adolescents. Objective: to summarize the clinical effect of reconstruction of medial patellofemoral collateral ligament with double pulley method in the treatment of juvenile acute patellar dislocation. Methods: thirty patients with acute dislocation of patella were treated with "double pulley method" for reconstruction of medial patellofemoral collateral ligament by the same group of doctors. Arthroscopic grinding head was used to make a small osseous groove along the long axis of patella at the middle point of patella and 1 / 3 of the upper middle of patella. To accommodate the tendon. At the midpoint of the patella and the upper third point of the midpoint of the patella in the alveolar bone, two double thread 5.0 anchors were inserted into the patellar articular surface parallel to the articular surface of the patella. Each of the two anchors had two knots, the other two reinforced sutures were made on the surrounding soft tissue, and the tendon was sutured into a femoral end. Form a "double pulley" structure. At the medial epicondyle and adductor nodule of the femur, a long longitudinal small incision was opened to expose the medial epicondyle and adductor tubercle. The deep fascia tunnel was opened between the two incisions, and the tendon was woven across the tunnel to establish the femoral end tunnel. The tendon is pulled out along the femoral tunnel, and the tensioning tendon is properly fastened, then the interfacial screw is pressed and fixed. The patella related parameters and knee joint function parameters were compared before and after ligament reconstruction for more than 10 months. Results and conclusion: 12 patients with intraarticular cartilage injury and 4 patients with meniscus injury were followed up with Q angle of patella obliquity angle at the last follow-up. The Lysholm score and IKDC score of knee joint function in the last follow-up were higher than those before reconstruction. The mean operation time was 90.0 卤10.5 min. 5) A case of patellar fracture caused by wrestling occurred in 1 patient with 0 掳-30 掳knee motion after ligamentum reconstruction. The results of open reduction and internal fixation of patellar fracture, no patellar dislocation, no positive patellar fear test, no infection, and poor wound healing showed that the double pulley method was simple and less traumatic. According to the stability of patellar anatomical structure, the patellar motion track is visible. The patient recovers quickly after ligament reconstruction, and the curative effect is good. If the application effect is not good, the secondary osteotomy can be performed again, which is one of the best surgical options for acute patellar dislocation.
【作者单位】：蚌埠医学院第二附属医院;安徽医科大学第一附属医院;
【分类号】：R726.8

【参考文献】