[1]米豫飞,苏春霞,邹春雨,等.经髌骨打结固定移植肌腱髌骨端解剖重建内侧髌股韧带治疗复发性髌骨脱位的临床研究[J].中医正骨,2020,32(06):12-17.
　MI Yufei,SU Chunxia,ZOU Chunyu,et al.A clinical study of transpatellar knotting fixation of patellar end of transplanted tendon in the surgery of anatomical reconstruction of medial patellofemoral ligament for treatment of recurrent patellar dislocation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2020,32(06):12-17.
点击复制

经髌骨打结固定移植肌腱髌骨端解剖重建内侧髌股韧带治疗复发性髌骨脱位的临床研究()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年06期
页码:
12-17
栏目:
临床研究
出版日期:
2020-06-20

文章信息/Info

Title:
A clinical study of transpatellar knotting fixation of patellar end of transplanted tendon in the surgery of anatomical reconstruction of medial patellofemoral ligament for treatment of recurrent patellar dislocation
作者:
米豫飞; 苏春霞; 邹春雨; 杨澜波; 乔清奎; 王战朝
(河南省洛阳正骨医院河南省骨科医院,河南洛阳471002)
Author(s):
MI Yufei; SU Chunxia; ZOU Chunyu; YANG Lanbo; QIAO Qingkui; WANG Zhanchao
Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
髌骨脱位;  复发;  内侧髌股韧带;  临床试验
Keywords:
patellar dislocation;  recurrence;  medial patellofemoral ligament;  clinical trial
摘要:
目的:探讨经髌骨打结固定移植肌腱髌骨端解剖重建内侧髌股韧带治疗复发性髌骨脱位的临床疗效和安全性。方法:回顾性分析采用解剖重建内侧髌股韧带治疗的60例复发性髌骨脱位患者的病例资料,其中移植肌腱髌骨端采用经髌骨打结固定者30例(打结固定组)、采用带线锚钉固定者30例(锚钉固定组)。比较2组患者的Lysholm评分、Kujala评分、屈膝30°时的髌骨倾斜角和髌骨适合角、髌骨脱位复发及并发症发生情况。结果:所有患者均获得随访,随访时间为6～18个月,中位数10个月。18例行胫骨结节内移的患者,胫骨结节均骨性愈合。①Lysholm评分。术前与术后6个月,2组患者Lysholm评分比较,差异均无统计学意义[(60.5±6.6)分,(58.4±7.6)分,t=0.243,P=0.404;(88.6±3.2)分,(87.8±4.6)分,t=0.354,P=0.362]; 术后6个月,2组患者Lysholm评分均较术前提高(t=-2.864,P=0.003; t=-3.057,P=0.002)。②Kujala评分。术前与术后6个月,2组患者Kujala评分比较,差异均无统计学意义[(53.5±5.2)分,(54.2±3.5)分,t=0.294,P=0.385;(80.9±7.6)分,(81.7±5.6)分,t=-0.287,P=0.388]; 术后6个月,2组患者Kujala评分均较术前提高(t=-3.364,P=0.001; t=-3.223,P=0.001)。③屈膝30°时的髌骨倾斜角。术前与术后6个月,2组患者屈膝30°时的髌骨倾斜角比较,差异均无统计学意义(12.5°±3.2°,12.3°±2.5°,t=0.326,P=0.373; 4.5°±2.5°,4.1°±2.7°,t=0.426,P=0.336); 术后6个月,2组患者屈膝30°时的髌骨倾斜角均较术前减小(t=1.986,P=0.028; t=2.183,P=0.018)。④屈膝30°时的髌骨适合角。术前与术后6个月,2组患者屈膝30°时的髌骨适合角比较,差异均无统计学意义(9.5°±1.2°,10.9°±2.3°,t=0.185,P=0.427; 1.5°±1.7°,1.9°±1.5°,t=-0.396,P=0.347); 术后6个月,2组患者屈膝30°时的髌骨适合角均较术前减小(t=2.426,P=0.010; t=2.537,P=0.008)。打结固定组3例、锚钉固定组2例发生切口脂肪液化,经换药治疗后愈合; 打结固定组和锚钉固定组各有2例发生膝关节屈曲功能障碍,行麻醉下手法松解后恢复正常。均无髌骨骨折及脱位。2组患者的并发症发生率和髌骨脱位复发率比较,差异均无统计学意义(P=1.000)。结论:在解剖重建内侧髌股韧带治疗复发性髌骨脱位时,移植肌腱髌骨端采用经髌骨打结固定与带线锚钉固定的短期疗效及安全性相当。
Abstract:
Objective:To explore the clinical curative effects and the safety of transpatellar knotting fixation of patellar end of transplanted tendon in the surgery of anatomical reconstruction of medial patellofemoral ligament(MPFL)for treatment of recurrent patellar dislocation.Methods:The medical records of 60 patients who received anatomical reconstruction of MPFL for treatment of recurrent patellar dislocation were analyzed retrospectively.The patellar end of transplanted tendon was fixed by transpatellar knotting(knotting fixation group)and suture anchors(anchor fixation group)respectively,30 cases in each group.The Lysholm scores,Kujala scores,patellar tilt angle(PTA)and patellar congruence angle(PCA)at 30 degrees of knee flexion,recurrence of patellar dislocation and complications were compared between the 2 groups.Results:All patients in the 2 groups were followed up for 6-18 months with a median of 10 months.Anteromedial tibial tubercle transfer was performed on 18 patients,and all patients got bone union in tibial tubercles.There was no statistical difference in Lysholm scores between the 2 groups before the surgery and at 6 months after the surgery(60.5+-6.6 vs 58.4+-7.6 points,t=0.243,P=0.404; 88.6+-3.2 vs 87.8+-4.6 points,t=0.354,P=0.362).The Lysholm scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=-2.864,P=0.003; t=-3.057,P=0.002).There was no statistical difference in Kujala scores between the 2 groups before the surgery and at 6 months after the surgery(53.5+-5.2 vs 54.2+-3.5 points,t=0.294,P=0.385; 80.9+-7.6 vs 81.7+-5.6 points,t=-0.287,P=0.388).The Kujala scores increased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=-3.364,P=0.001; t=-3.223,P=0.001).There was no statistical difference in PTA at 30 degrees of knee flexion between the 2 groups before the surgery and at 6 months after the surgery(12.5+-3.2 vs 12.3+-2.5 degrees,t=0.326,P=0.373; 4.5+-2.5 vs 4.1+-2.7 degrees,t=0.426,P=0.336).The PTA at 30 degrees of knee flexion decreased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=1.986,P=0.028; t=2.183,P=0.018).There was no statistical difference in PCA at 30 degrees of knee flexion between the 2 groups before the surgery and at 6 months after the surgery(9.5+-1.2 vs 10.9+-2.3 degrees,t=0.185,P=0.427; 1.5+-1.7 vs 1.9+-1.5 degrees,t=-0.396,P=0.347).The PCA at 30 degrees of knee flexion decreased in the 2 groups at 6 months after the surgery compared to pre-surgery(t=2.426,P=0.010; t=2.537,P=0.008).The incision fat liquefaction was found in 3 patients in knotting fixation group and 2 patients in anchor fixation group,and the incisions healed after dressing change.The knee flexion dysfunction was found in 2 patients in knotting fixation group and 2 patients in anchor fixation group,and the patients recovered after treatment with manipulation release under anesthesia.No complications such as patellar fracture and dislocation were found in the 2 groups.There was no statistical difference in complication incidence rate and patellar dislocation recurrence rate between the 2 groups(P=1.000).Conclusion:The transpatellar knotting fixation and suture anchor fixation of patellar end of transplanted tendon are similar to each other in short-term curative effects and safty in surgery of anatomical reconstruction of MPFL for treatment of recurrent patellar dislocation.

参考文献/References:

[1]ALVAREZ O,STEENSEN R N,RULLKOETTER P J,et al.Computational approach to correcting joint instability in patients with recurrent patellar dislocation[J].J Orthop Res,2020,38(4):768-776.
[2]SCHNEIDER D K,GRAWE B,MAGNUSSEN R A,et al.Outcomes after isolated medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar dislocations:a systematic review and meta-analysis[J].Am J Sports Med,2016,44(11):2993-3005.
[3]JOHNSON D S,TURNER P G.Management of the first-time lateral patellar dislocation[J].Knee,2019,26(6):1161-1165.
[4]STEIN B E S,GRUBER S,BRADY J M.MPFL in first-time dislocators[J].Curr Rev Musculoskelet Med,2018,11(2):182-187.
[5]HUNTINGTON L S,WEBSTER K E,DEVITT B M,et al.Factorsassociated with an increased risk of recurrence after a first-time patellar dislocation:a systematic review and meta-analysis[JOL].Am J Sports Med,2019[2019-10-20].http:sage.cnpereading.comparagraphdownload10.11770363546519888467.
[6]DESAI V S,TAGLIERO A J,PARKES C W,et al.Systematic review of medial patellofemoral ligament reconstruction techniques:comparison of patellar bone socket and cortical surface fixation techniques[J].Arthroscopy,2019,35(5):1618-1628.
[7]刘继军,武琪,段力军,等.带袢钛板单骨道重建与骨槽带线锚钉双束重建内侧髌股韧带治疗复发性髌骨脱位的疗效比较[J].中华骨与关节外科杂志,2018,11(11):849-853.
[8]NOYES F R.Noyes’kneedisorders:surgery,rehabilitation,clinical outcomes[M].2nd ed.Philadelphia:Elsevier Inc,2017:980-983.
[9]SMITH M K,WERNER B C,DIDUCH D R.Avoidingcomplications with MPFL reconstruction[J].Curr Rev Musculoskelet Med,2018,11(2):241-252.
[10] SHAH J N,HOWARD J S,FLANIGAN D C,et al.A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation[J].Am J Sports Med,2012,40(8):1916-1923.
[11] 冯华,张辉.髌股关节不稳定临床评估与治疗[M].北京:人民军医出版社,2014:16-17.
[12] DEJOUR D,COULTRE B L.Osteotomies in patello-femoral instabilities[J].Sports Med Arthrosc Rev,2007,15(1):39-46.
[13] INSALL J,FALVO K A,WISE D W.Chondromalacia patellae.A prospective study[J].J Bone Joint Surg Am,1976,58(1):1-8.
中医正骨2020年6月第32卷第6期J Trad Chin Orthop Trauma,2020,Vol.32,No.6(总417)
(总418)中医正骨2020年6月第32卷第6期J Trad Chin Orthop Trauma,2020,Vol.32,No.6
[14] MCGEE T G,COSGAREA A J,MCLAUGHLIN K,et al.Rehabilitation after medial patellofemoral ligament reconstruction[J].Sports Med Arthrosc Rev,2017,25(2):105-113.
[15] LYSHOLM J,GILLQUIST J.Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale[J].Am J Sports Med,1982,10(3):150-154.
[16] KUJALA U M,JAAKKOLA L H,KOSKINEN S K,et al.Scoring of patellofemoral disorders[J].Arthroscopy,1993,9(2):159-163.
[17] FUCENTESE S F.Patellofemoralinstability[J].Orthopade,2018,47(1):77-86.
[18] TRINH T Q,FERREL J R,BENTLEY J C,et al.Theanatomy of the medial patellofemoral ligament[J].Orthopedics,2017,40(4):e583-e588.
[19] CHOUTEAU J.Surgical reconstruction of the medial patellofemoralligament[J].Orthop Traumatol Surg Res,2016,102(1 Suppl):S189-S194.
[20] SONG J G,KANG S B,OH S H,et al.Medialsoft-tissue realignment versus medial patellofemoral ligament reconstruction for recurrent patellar dislocation:systematic review[J].Arthroscopy,2016,32(3):507-516.
[21] 姚俊娜,权松涛,冯伟,等.双束半腱肌肌腱解剖重建MPFL治疗复发性髌骨脱位[J].中医正骨,2018,30(8):54-57.
[22] VASSO M,CORONA K,TORO G,et al.Anatomic double-bundle medial patellofemoral ligament reconstruction with autologous semitendinosus:aperture fixation both at the femur and the patella[J].Joints,2017,5(4):256-260.
[23] AZAR F M,BEATY J H,CANALEST.Campbell’s operative orthopaedics[M].13rd ed.Philadelphia:Elsevier Inc,2017:11-14.
[24] PATEL N K,DE SA D,VASWANI R,et al.Kneeflexion angle during graft fixation for medial patellofemoral ligament reconstruction:a systematic review of outcomes and complications[J].Arthroscopy,2019,35(6):1893-1904.
[25] GE?EIN M,ROESSLER P P,SCHüTTLER K F,et al.Complications and failure of MPFL reconstruction with free tendon grafts in cases of patellofemoral instability[J].Technol Health Care,2015,23(5):659-666.

相似文献/References:

[1]杨久山.关节镜下髌外侧支持带松解联合内侧髌股韧带重建 治疗复发性髌骨脱位[J].中医正骨,2015,27(08):38.
[2]陈丽,张晓华,司珂.耳穴贴压和中药敷脐在儿童习惯性髌骨脱位伸膝装置重建术后护理中的应用[J].中医正骨,2018,30(05):79.
[3]姚俊娜,权松涛,冯伟,等.双束半腱肌肌腱解剖重建内侧髌股韧带 治疗复发性髌骨脱位[J].中医正骨,2018,30(08):54.
[4]张麟,陈洪波,周广文,等.“治病求本，筋骨并重”理论及其对治疗复发性髌骨脱位的指导意义[J].中医正骨,2019,31(12):54.
[5]陈荦,顾圣华,章培峰,等.关节镜辅助定位股骨隧道重建内侧髌股韧带治疗复发性髌骨脱位的临床研究[J].中医正骨,2021,33(07):11.
　CHEN Luo,GU Shenghua,ZHANG Peifeng,et al.A clinical study of femoral tunnel positioning assisted by arthroscopy in medial patellofemoral ligament reconstruction for treatment of recurrent patellar dislocation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(06):11.
[6]于开凡,陈日高,何东霖,等.复发性腰椎间盘突出症影像学危险因素的研究进展[J].中医正骨,2024,36(01):50.
[7]谢兴文,吕立桃,王春亮,等.复发性髌骨脱位的病因及诊治进展[J].中医正骨,2016,28(08):66.

备注/Memo

备注/Memo:
(收稿日期:2020-01-05本文编辑:李晓乐)通讯作者:米豫飞E-mail:miyufei@163.com
更新日期/Last Update: 2020-10-10