摘要
目的探讨改良全关节镜下内侧髌股韧带(MPFL)重建术治疗复发性髌骨脱位的疗效。方法采用回顾性病例系列研究分析2017年1月至2020年1月深圳大学第一附属医院收治的38例(46膝)复发性髌骨脱位患者的临床资料,其中男12例(12膝),女26例(34膝);年龄14~40岁[(24.6±5.4)岁]。患者均行改良全关节镜下MPFL重建术。术后即刻行CT三维重建评估MPFL股骨侧骨隧道定位点。术后6,12个月采用MRI检查观察MPFL的愈合形态。术前、术后6,12个月及末次随访时采用膝关节功能Lysholm评分、Kujala评分评估膝关节功能。记录恢复运动时间。观察并发症情况。结果患者均获随访26~48个月[(32.4±8.6)个月]。术后即刻CT三维重建显示,MPFL股骨侧骨隧道定位点均位于收肌结节与股骨内上髁沟槽区域内。术后6,12个月MRI T2像显示重建的MPFL为低信号、张力良好的韧带组织,提示MPFL愈合良好。术后6,12个月及末次随访时膝关节功能Lysholm评分为(81.1±12.0)分、(91.2±3.8)分、(92.2±9.8)分,明显高于术前的(52.4±10.6)分(P均<0.01)。术后6,12个月及末次随访时膝关节功能Kujala评分为(85.4±3.9)分、(91.4±3.6)分、(93.1±8.5)分,明显高于术前的(55.2±6.8)分(P均<0.01)。与术后6个月相比,术后12个月及末次随访时膝关节功能Lysholm评分及Kujala评分明显提高(P均<0.05)。患者均重返运动,恢复运动时间为3~12个月[(8.7±2.3)个月]。1例患者术后切口愈合不良,经过换药伤口愈合。未出现切口感染、神经损伤、关节僵硬、髌骨脱位复发等并发症。结论改良全关节镜下MPFL重建术治疗复发性髌骨脱位,骨隧道定位准确,韧带愈合良好,功能恢复好,可以早期重返运动,术后并发症少。
Objective To evaluate the clinical efficacy of modified all⁃arthroscopic reconstruction of medial patella femoral ligament(MPFL)for the treatment of recurrent patellar dislocation.Methods A retrospective case series study was conducted to analyze the clinical data of 38 patients(46 knees)with recurrent patellar dislocation,who were treated at First Affiliated Hospital of Shenzhen University from January 2017 to January 2020.The patients included 12 males(12 knees)and 26 females(34 knees),aged 14⁃40 years[(24.6±5.4)years].All patients underwent the modified all⁃arthroscopic MPFL reconstruction procedure.The femoral tunnel locations were assessed by 3D⁃CT immediately after surgery.The MRI was performed at 6 and 12 months after operation to assess the healing morphology of the reconstructed MPFL.The Lysholm score and Kujala score were used to assess the knee function before operation,at 6 months after operation,at 12 months after operation and at the last follow⁃up.The time to return to sports as well as complications were observed.Results All patients were followed up for 26⁃48 months[(32.4±8.6)months].Postoperative 3D⁃CT examination showed that the femoral tunnels were located in the groove area of the medial epicondyle of the femur and the adductor tubercle.At 6 and 12 months after operation,MRI T2 images showed that the reconstructed MPFL had a low signal and well tensioned ligament tissue,indicating that the MPFL was healed well.The Lysholm scores at 6 and 12 months postoperatively and at the last follow⁃up were(81.1±12.0)points,(91.2±3.8)points,and(92.2±9.8)points,respectively,being significantly higher than the preoperative(52.4±10.6)points(all P<0.01).The Kujala scores at 6 and 12 months postoperatively and at the last follow⁃up were(85.4±3.9)points,(91.4±3.6)points,and(93.1±8.5)points,respectively,being significantly higher than the preoperative(55.2±6.8)points(all P<0.01).Compared with 6 months postoperatively,the Lysholm score and Kujala score were significantly improved at 12 months postoperatively and at the last follow⁃up(all P<0.05).All patients returned to sports,with the time to return to sports for 3⁃12 months[(8.7±2.3)months]after operation.One patient had poor wound healing but was healed after dressing changes.No wound infection,nerve injury,joint stiffness,patella re⁃dislocation or other complications occurred.Conclusion For recurrent patellar dislocation,the modified all⁃arthroscopic MPFL reconstruction has advantages of accurate bone tunnel positioning,good ligament healing,good function recovery,early return to sports,and less postoperative complications.
作者
钟名金
崔家鸣
黄子荣
蔡宇银
冯文哲
陈康
欧阳侃
杨雷
王大平
王满宜
朱伟民
Zhong Mingjin;Cui Jiaming;Huang Zirong;Cai Yuyin;Feng Wenzhe;Chen Kang;Ouyang Kan;Yang Lei;Wang Daping;Wang Manyi;Zhu Weimin(Department of Sports Medicine,First Affiliated Hospital of Shenzhen University(Shenzhen Second People′s Hospital),Shenzhen 518000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第8期695-702,共8页
Chinese Journal of Trauma
关键词
关节镜检查
髌骨脱位
韧带
内侧髌股韧带
Arthroscopy
Patellar dislocation
Ligaments
Medial patellofemoral ligament
