[1]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):11-16.
 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(07):11-16.
点击复制

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()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年07期
页码:
11-16
栏目:
临床研究
出版日期:
2021-07-20

文章信息/Info

Title:
A clinical study of femoral tunnel positioning assisted by arthroscopy in medial patellofemoral ligament reconstruction for treatment of recurrent patellar dislocation
作者:
陈荦顾圣华章培峰周建烽
(诸暨市第二人民医院,浙江 诸暨 311811)
Author(s):
CHEN LuoGU ShenghuaZHANG PeifengZHOU Jianfeng
The Second People’s Hospital of Zhuji city,Zhuji 311811,Zhejiang,China
关键词:
髌骨脱位 关节镜检查 修复外科手术 内侧髌股韧带 股骨隧道
Keywords:
patellar dislocation arthroscopy reconstructive surgical procedures medial patellofemoral ligament femoral tunneling
摘要:
目的:探讨关节镜辅助定位股骨隧道重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗复发性髌骨脱位的临床疗效和安全性。方法:对80例复发性髌骨脱位患者的病例资料进行回顾性分析,根据MPFL重建术中股骨隧道定位方式的不同分为关节镜定位组(采用关节镜辅助定位,42例)和触摸定位组(采用触摸股骨骨性标志定位,38例)。比较2组患者的手术时间、切口长度、术中出血量、股骨隧道等距隧道率、髌骨角、膝关节Lysholm评分、美国膝关节协会(the American Knee Society,AKS)评分及并发症发生率。结果:①一般结果。关节镜定位组手术时间、手术切口均短于触摸定位组,术中出血量少于触摸定位组[(65.4±6.4)min,(94.5±7.8)min,t=5.151,P=0.012;(4.1±0.3)cm,(8.2±1.8)cm,t=8.893,P=0.001;(149.7±24.5)mL,(207.2±30.3)mL,t=9.384,P=0.000]。2组患者随访时间12~18个月,中位数14个月。②股骨隧道等距隧道率和髌骨角。关节镜定位组等距点距离1.52~5.14 mm(中位数3.25 mm),股骨隧道均为等距隧道; 触摸定位组等距点距离5.33~9.17 mm(中位数7.32 mm),股骨隧道为等距隧道者12例; 关节镜定位组股骨隧道等距隧道率高于触摸定位组(P=0.000)。关节镜定位组髌骨角大于触摸定位组(12.2°±4.1°,10.3°±3.9°,t=9.482,P=0.000)。③膝关节评分。术前2组患者膝关节 Lysholm评分、AKS评分组间比较,差异均无统计学意义[(38.07±1.48)分,(37.94±1.53)分,t=8.682,P=0.189;(43.22±4.77)分,(42.74±4.68)分,t=9.358,P=0.248]; 末次随访时,关节镜定位组膝关节Lysholm评分、AKS评分均高于触摸定位组[(95.47±0.49)分,(90.23±0.51)分,t=1.673,P=0.028;(96.25±0.59)分,(91.47±0.73)分,t=1.248,P=0.002]。④并发症发生率。术后关节镜定位组出现关节腔积血1例,触摸定位组出现切口感染2例、髌骨再脱位1例; 2组患者并发症发生率比较,差异无统计学意义(χ2=0.380,P=0.538)。结论:关节镜辅助定位股骨隧道重建MPFL治疗复发性髌骨脱位,与用手触摸骨性标志定位股骨隧道相比,切口小、手术时间短、术中出血少,股骨隧道定位更准确,髌骨复位更好,更有利于膝关节功能的恢复,但两者的安全性相当。
Abstract:
To explore the clinical curative effects and safety of femoral tunnel(FT)positioning assisted by arthroscopy in medial patellofemoral ligament(MPFL)reconstruction for treatment of recurrent patellar dislocation(RPD).Methods:The medical records of 80 patients who underwent MPFL reconstruction for treatment of RPD were analyzed retrospectively.The patients were divided into 2 groups according to FT positioning methods.The arthroscopic-assisted positioning method was used in 42 patients(AA positioning group),while palpation(palpating femoral bony landmarks)positioning method was used in 38 patients(palpation positioning group).The operative time,incision length,intraoperatve blood loss,FT isometric tunnel rate,patella angle,Lysholm knee score,the American Knee Society(AKS)score and complication incidence were compared between the 2 groups.Results:The operative time and incision length were shorter and the intraoperatve blood loss was less in AA positioning group compared to palpation positioning group(65.4±6.4 vs 94.5±7.8 minutes,t=5.151,P=0.012; 4.1±0.3 vs 8.2±1.8 cm,t=8.893,P=0.001; 149.7±24.5 vs 207.2±30.3 mL,t=9.384,P=0.000).All patients in the 2 groups were followed up for 12-18 months with a median of 14 months.The isometric point distance was 1.52-5.14 mm with a median of 3.25 mm,and all of the FTs were isometric tunnels in AA positioning group; while,in palpation positioning group,the isometric point distance was 5.33-9.17 mm with a median of 7.32 mm,and the isometric tunnels were found in 12 patients.The FT isometric tunnel rate was higher in AA positioning group compared to palpation positioning group(P=0.000),and the patella angles were greater in AA positioning group in contrast to palpation positioning group(12.2±4.1 vs 10.3±3.9 degrees,t=9.482,P=0.000).There was no statistical difference in Lysholm knee scores and AKS scores between the 2 groups before the surgery(38.07±1.48 vs 37.94±1.53 points,t=8.682,P=0.189; 43.22±4.77 vs 42.74±4.68 points,t=9.358,P=0.248).The Lysholm knee scores and AKS scores were higher in AA positioning group compared to palpation positioning group at last follow-up(95.47±0.49 vs 90.23±0.51 points,t=1.673,P=0.028; 96.25±0.59 vs 91.47±0.73 points,t=1.248,P=0.002).After the surgery,the articular cavity hematocele(1 case)was found in AA positioning group; while incision infection(2 cases)and patellar redislocation(1 case)were found in palpation positioning group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.380,P=0.538).Conclusion:Compared to palpation positioning in MPFL reconstruction for treatment of RPD,FT positioning assisted by arthroscopy has such advantages as smaller incision,shorter operative time,less intraoperative blood loss and more accurate FT positioning,and it can be more conducive to patellar reduction and knee function recovery,while the two methods are similar to each other in the safety.

参考文献/References:

[1] 黄勇,苏帆,陈斐,等.内侧髌股韧带重建的股骨侧骨道预定位[J].中国矫形外科杂志,2021,29(6):540-543.
[2] 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(8):66-69.
[3] 朱宝玉,于晓杰,肖盛世,等.关节镜辅助下内侧髌股韧带重建治疗青少年复发性髌骨脱位[J].中国医师杂志,2019,21(4):565-568.
[4] 左永祥,马子平.股骨侧Tightrope固定重建内侧髌股韧带治疗创伤性髌骨脱位[J].中国骨伤,2017,30(11):1039-1042.
[5] 余振阳,蔡谞,谷旺.关节镜辅助下解剖重建内侧髌股韧带治疗习惯性髌骨脱位[J].中国骨伤,2017,30(4):295-299.
[6] BAUMANN C A,PRATTE E L,SHERMAN S L,et al.Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes:a systematic review[J].Knee Surg Sports Traumatol Arthrosc,2018,26(10):2920-2933.
[7] 林圆,徐斌,涂俊,等.自体单束前交叉韧带移植重建不同股骨隧道位置对髌股关节的影响[J].中国组织工程研究,2020,24(14):2140-2146.
[8] 雷鸣鸣,华强.内侧髌股韧带重建术中股骨隧道预先定位研究[J].中国修复重建外科杂志,2019,33(5):546-550.
[9] CANALE S T,BEATY J H.坎贝尔骨科手术学[M].卢世璧,王继芳,王岩,等译.10版.济南:山东科学技术出版社,2005:2284-2297.
[10] 张旭,吴建伟,李岳瑞,等.关节镜辅助外侧松解+自体半腱肌移植治疗髌骨习惯性脱位[J].中国伤残医学,2017,25(24):36-38.
[11] 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.
[12] 蒋协远,王大伟.骨科临床疗效和评价标准[M].北京:人民卫生出版社,2005.
[13] 刘阳,尼加提·阿不力米提,孙学斌,等.骨骺未闭的青少年内侧髌骨韧带重建术中股骨隧道定位点的研究[J].新疆医科大学学报,2017,40(6):747-750.
[14] 魏增永,王波,罗建成.关节镜辅助下半腱肌解剖重建内侧髌股韧带治疗复发性髌骨脱位[J].实用骨科杂志,2019,25(1):74-76.
[15] 奚国斌.关节镜辅助下内侧髌股韧带三点重建治疗复发性髌骨脱位[J].临床医药文献电子杂志,2017,4(44):8592-8593.
[16] REDLER L H,MEYERS K N,BRADY J M,et al.Anisometry of medial patellofemoral ligament reconstruction in the setting of increased tibial tubercle-trochlear groove distance and patella alta[J].Arthroscopy,2018,34(2):502-510.
[17] 李振伟,黄德刚,韩冠生,等.关节镜辅助下内侧髌股韧带双束重建治疗复发性髌骨脱位[J].皖南医学院学报,2017,36(4):346-348.
[18] 朱宝玉,于晓杰,肖盛世,等.关节镜辅助下内侧髌股韧带重建治疗青少年复发性髌骨脱位[J].中国医师杂志,2019,21(4):565-568.
[19] 程峰,殷振宇,汪志芳,等.透射定位法在复发性髌骨脱位重建内侧髌股韧带中的应用[J].中华关节外科杂志(电子版),2018,12(6):863-867.
[20] 邱洪九,李帅峰,谢川江,等.计算机导航系统辅助前交叉韧带重建术定位的准确性及其效果[J].中华创伤杂志,2020,36(2):183-189.

相似文献/References:

[1]孟维娜,明立功,王新德,等.关节镜下清理联合腓骨近1/3段截骨治疗膝骨关节炎[J].中医正骨,2015,27(11):40.
[2]李艺彬,朱勇,吴昭克.关节镜下多入路全关节滑膜清理术治疗肘关节类风湿关节炎[J].中医正骨,2015,27(11):56.
[3]谢凯罗,董伊隆,张力成.前交叉韧带单束解剖重建术股骨隧道定位的X线评估[J].中医正骨,2015,27(10):11.
 XIE Kailuo,DONG Yilong,ZHANG Licheng.Roentgenologic evaluation of femoral tunnel positioning in anterior cruciate ligament single-bundle anatomical reconstruction[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):11.
[4]王鼎,陈达,何伟,等.关节镜下Fast-Fix缝合术后半月板的愈合情况观察[J].中医正骨,2015,27(08):36.
[5]申晟,尚延春,孟庆阳.自体与同种异体肌腱关节镜下重建前交叉韧带的对比研究[J].中医正骨,2015,27(07):34.
 SHEN Sheng,SHANG Yanchun,MENG Qingyang.A retrospective trial of autologous tendon versus allogeneic tendon for arthroscopic anterior cruciate ligament reconstruction[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):34.
[6]张华,李贵山.关节镜下清理术联合关节腔内注射玻璃酸钠 治疗膝骨关节炎[J].中医正骨,2015,27(07):53.
[7]姚五平,邢涛,李磊,等.前交叉韧带部分损伤后关节镜下保留残束 重建与单束重建的对比研究[J].中医正骨,2015,27(12):24.
 YAO Wuping,XING Tao,LI Lei,et al.A retrospective trial of arthroscopic reconstruction with residual-bundle reserved versus single-bundle reconstruction for treatment of anterior cruciate ligament partial injury[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):24.
[8]倪力刚,胡劲涛.关节镜清理术联合中药薰蒸与单纯关节镜清理术治疗 早期膝骨关节炎的对比研究[J].中医正骨,2015,27(12):41.
 NI Ligang,HU Jintao.A retrospective trial of arthroscopic debridement integrated and nonintegrated with Chinese herbal steaming for treatment of early knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(07):41.
[9]王庆东,李付彬,徐向峰,等.关节镜下可吸收螺钉内固定治疗儿童胫骨髁间嵴骨折[J].中医正骨,2015,27(12):52.
[10]蒙剑德,夏贤生,赵小泉,等.功能锻炼联合中药薰蒸在膝关节半月板损伤关节镜下 成形术后康复治疗中的应用[J].中医正骨,2015,27(06):37.
[11]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.
[12]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.

更新日期/Last Update: 1900-01-01