改良单骨道双束重建内侧髌股韧带治疗复发性髌骨脱位的临床研究

摘要

Objective:To investigate the potential clinical value of improved single bone tunnel double-bundle reconstruction method in the treatment of recurrent patellar dislocation.Method: Perform improved single bone tunnel double-bundle reconstruction technique to reconstruct medial patollofemoral ligament with combining treatments of lateral retinaculum release and medial tibial tubercle transfer on thirty-three recurrent patellar dislocation patients. After operation, check the incision healing condition, patellar stability, knee X and compare patellar adapter angle, patellar tilt angle and lateral patellofemoral angle to evaluate the knee function by using Lysholm and Kujala score.Result: All follow-ups of thirty-three cases lasted for 8 to 15 months. Incision healing on schedule, no infection, patellar stable and reversion of motor ability. All thirty-three cases showed no sign of patellar dislocation. Two groups of patellar adapter angle (21.8±5.9)°,(-2.5± 4.0)°, patellar tilt angle (24.9±5.8)°,(14.8±4.2)° and lateral patellofemoral angle (-6.1±2.3)°,(5.4±1.6)°before and after operation were as shown. Lysholm score before and after operation were respectively (35.10±9.31)and (89.11±5.21). Kujala score before and after operation were respectivel(36.26±13.36) and(90.45±4.55). Data difference showed statistical significance.Conclusion: Using improved single bone tunnel double-bundle reconstruction technique to reconstruct medial patollofemoral ligament is easy to perform, very stable, economical and has few compliments. Combining with lateral retinaculum release and medial tibial tubercle transfer can achieve better effect.%目的：探讨改良单骨道双束重建内侧髌股韧带治疗复发性髌骨脱的临床应用价值。方法：对33例复发性髌骨脱位患者行改良单骨道技术双束重建内侧髌股韧带联合关节镜下髌骨外侧支持带松解加胫骨结节内移治疗。术后观察切口愈合情况，髌骨稳定性，膝关节X片检查测量对比术前、术后髌骨适配角、髌骨倾斜角、外侧髌股角，采用Lysholm和Kujala评分评估膝关节功能。结果：33例均获随访，时间8~15个月，平均（12±3.1）月。切口按期愈合，无感染，髌骨稳定，运动能力恢复，33例病例均无髌骨再脱位，两组患者的术前、术后髌骨适配角为（21.8±5.9）°、（-2.5±4.0）°，髌骨倾斜角（24.9±5.8）°、（14.8±4.2）°，外侧髌股角（-6.1±2.3）°、（5.4±1.6）°。Lysholm评分术前、术后分别为（35.10±9.31）分和（89.11±5.21）分， Kujala评分术前、术后分别为（36.26±13.36）分和（90.45±4.55）分，比较差异有统计学意义（P<0.05）。结论：改良单骨道双束重建技术重建内侧髌股韧带具有操作简单，牢固可靠、并发症少、住院费用低的优点，联合关节镜下髌骨外侧支持带松解加胫骨结节内移，可取的良好的治疗效果。