弧形骨槽联合骨筋膜覆盖技术双束解剖重建内侧髌股韧带

发布时间：2018-07-17 06:37

【摘要】：[目的]探讨弧形骨槽联合髌内侧骨筋膜覆盖技术双束解剖重建内侧髌股韧带(medial patella femoral ligament,MPFL)治疗复发性髌骨脱位的中短期临床效果。[方法]回顾本院2012年2月~2015年10月诊断为复发性髌骨脱位的患者25例,其中男11例,女14例,年龄13~35岁,平均20.7岁,手术以收肌结节与股骨内上髁最高点连线的中点作为MPFL股骨止点并建立7 mm骨道,髌骨内缘1/3做髌骨侧止点,使用磨钻于该止点建立约2 cm的弧形骨槽以充分包埋移植物并用骨筋膜充分覆盖和固定移植物。将移植物两游离缘由髌骨侧从股内侧肌斜束与关节囊之间自股骨侧切口穿出并于骨道内口用可吸收界面螺钉固定。临床评价包括手术前后的Kujala、Lysholm和Tegner评分,影像学分析包括手术前后的髌股适合角(congruance angle,CA),髌骨倾斜角(patellar tilt angle,PTA),髌骨外移率(patellar lateral shift ratio,PLSR)。[结果]术后随访时间均在12个月以上,平均(18.84±4.95)个月,未见复发、感染等相关并发症。所有患者术后Kujala、Lysholm和Tegner临床评分较术前均有显著性改善(P0.05)。所有患者影像学指标均恢复至正常范围,术前术后改变差异具有统计学意义(P0.05)。[结论]弧形骨槽联合髌内侧骨筋膜覆盖技术双束解剖重建MPFL具有切口小、复发率低等优点,中短期临床疗效满意。
[Abstract]:[objective] to investigate the short and medium term clinical effect of double bundle anatomical reconstruction of medial patellofemoral ligament (medial patella femoral ligamentum) with arc bone groove combined with medial patellar fascia covering technique in the treatment of recurrent patellar dislocation. [methods] from February 2012 to October 2015, 25 patients with recurrent patellar dislocation were reviewed, including 11 males and 14 females, aged 1335 years with an average of 20.7 years. The midpoint of the line between adductor tubercle and the highest point of the medial epicondyle of the femur was used as the midpoint of MPFL femur, and the 7 mm bone canal was established, and the patellar lateral insertion point was made at 1 / 3 of the inner edge of the patella. An arcuate bone groove of about 2 cm was established by grinding at the insertion point to fully embed the graft and to adequately cover and fix the graft with the osseous fascia. The patellar side of the graft was perforated from the femoral incision between the medial femoral muscle oblique bundle and the articular capsule and fixed with absorbable interface screws at the internal orifice of the bone canal. The clinical evaluation included the preoperative and postoperative Kujalahe Lysholm and Tegner scores. The imaging analysis included the patellofemoral angle (congruance angle CA), the patellar obliquity angle (patellar tilt angle( patellar tilt), and the patellar outward migration rate (patellar lateral shift (patellar lateral shift). [results] all the patients were followed up for more than 12 months, with an average of (18.84 卤4.95) months. No recurrence, infection and other related complications were found. The clinical scores of Kujalahe Lysholm and Tegner were significantly improved after operation (P0.05). All the imaging indexes returned to normal range, the difference of preoperative and postoperative changes was statistically significant (P0.05). [conclusion] double bundle anatomical reconstruction of MPFL with arc-shaped bone groove combined with medial patellar fascia covering technique has the advantages of small incision and low recurrence rate. The short and medium term clinical effect is satisfactory.
【作者单位】：河北医科大学第三医院关节二科;
【分类号】：R687.4

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