[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.
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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()
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《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 Luo; GU Shenghua; ZHANG Peifeng; ZHOU 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.

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更新日期/Last Update: 1900-01-01