自体腓骨长肌腱前1/2双束解剖重建内侧髌股韧带联合外侧支持带松解治疗复发性髌骨脱位12例报告及文献复习

摘要

Objective:To observe the process and curative effect of 12 cases of recurrent patellar dislocation treated by double bundle medial patellofemoral ligament (MPFL)reconstruction with anterior half peroneus longus and lateral retinacular release,and to investigate the etiology and treatment method of recurrent patellar dislocation. Methods:A total of 12 patients with recurrent patellar dislocation were enrolled in this study,the MPFL was reconstructed with the anterior half peroneus longus,patellar fixation with suture anchors was completed with 2 parallel 5.0 mm anchors which were spaced 1.0 cm apart at the anatomic insertion site of the native MPFL,the femoral side was secured with a interference screw,and the lateral retinaculum was released at the same time.The Lysholm score,IKDC score,congruence angle,J sign,grind test,and apprehension test of the patients before and after operation were detected.Results:The mean follow-up period was 16.4 months,and the Lysholm score of the patients before operation was lower than the last follow-up (t = 9.03,P < 0.001);the IKDC score of the patients before operation was lower than the last follow-up (t = 9.75,P < 0.001);the congruence angle of the patients before operation was larger than after operation (t = 7.22,P <0.001).All of the patients demonstrated the positive results before operation in J sign,grind test,and apprehension test,and the negative results in J sign, grind test,and apprehension test after operation.No patient appeared pateela fracture and recurrence of patellar dislocation during the follow-up period.Conclusion:The curative effect of reconstruction of the MPFL with anterior half peroneus longus combined with lateral retinacular release is well in the treatment of recurrent patellar dislocation,which is suitable for clinical promotion.%目的:观察自体腓骨长肌腱前1/2双束解剖重建内侧髌股韧带(MPFL)联合外侧支持带松解治疗12例复发性髌骨脱位的手术过程和疗效,探讨复发性髌骨脱位的病因及治疗方法.方法:收集12例复发性髌骨脱位患者,取自体腓骨长肌腱前1/2双束解剖重建MPFL,髌骨侧使用2枚带线锚钉固定于其解剖止点,2枚锚钉间距约1 cm,股骨侧以1枚界面螺钉挤压固定,同时行膝关节外侧支持带松解.观察患者手术前后膝关节Lysholm评分、IKDC评分、髌骨适合角、J型征、髌骨研磨试验和髌骨恐惧试验情况.结果:所有患者平均随访16.4个月,术前膝关节Lysholm评分低于末次随访(t=9.03,P<0.01);术前IKDC评分低于末次随访(t=9.75,P<0.01);术前髌骨适合角大于术后(t=7.22,P<0.01);术前患者J型征、髌骨研磨试验和髌骨恐惧试验(+),术后患者J型征、髌骨研磨试验和髌骨恐惧试验(-).患者术后均未发生髌骨骨折及再次脱位.结论:取自体腓骨长肌腱前1/2双束解剖重建MPFL联合外侧支持带松解术治疗复发性髌骨脱位疗效好,适合临床推广.