内侧髌股韧带重建术治疗复发性髌骨脱位的疗效研究

目的探讨游离肌腱移植重建内侧髌股韧带的手术方法及治疗复发性髌骨脱位的疗效。方法自2006年6月至2012年7月收治复发性髌骨脱位患者共40例（47膝），男10例（12膝），女30例（35膝），年龄7～51岁，平均19．4岁。全部经膝关节镜检最后确诊，其中43膝采用游离自体半腱肌，4膝采用异体肌腱，通过髌骨双隧道移植重建内侧髌股韧带，镜下动态调整移植肌腱的张力，使髌股关节对合达到正常，并用挤压螺钉将肌腱游离端固定在股骨止点。其中8例（10膝）同时行髌韧带止点内移术。结果有36例（42膝）患者获得随访，随访时间3—70个月，平均随访23个月。临床疗效评价包括髌骨主观稳定性评估、Lysholm膝关节评分及Insall疗效标准（1976年）。术后髌骨外推试验和恐惧试验均为阴性。手术前后Lysholm评分术前平均为（63．1±9．1）分，术后评分为（87．1±6．4）分，手术前后的差异有统计学意义（t=21．7，P〈0．05）。按Insall疗效标准，优良率为85．7％。结论采用以游离肌腱重建MPFL为主的综合术式治疗复发性髌骨脱位，手术效果满意。

Efficacy of medial patellofemoral ligament reconstruction in treatment of recurrent patellar dislocation

Objective To investigate the medial patellofemoral ligament （MPFL） reconstruction with free tendon graft and its efficacy in the treatment of recurrent patellar dislocation, Methods Between June 2006 and July 2012, 40 patients （47 knees） with recurrent dislocation of the patella were included in this study, among which there were 10 males （12 knees） and 30 females （35 knees）. The average age was 19. 4 years old （range, 7 -51 years）. All were confirmed by knee arthroscopy. 43 knees were used free self-semitendinosus tendon and four knees were used allograft tendon. The medial patellofemoral ligament was reconstructed through the double-patella tunnel. The tension of the graft was adjusted dynamically under arthroscopy until the patellofemoral joint properly fit. Extrusion screw was used to fix the free end of tendon in femoral insertion point. Ingression of patella ligament insertion was performed in eight patients （10 knees） simultaneously. Results 36 patients （42 knees） were followed up for three to 70 months, 23 months in average. Clinical evaluation included patellar stability of subjective assessment, Lysholm knee score and the Insall efficacy standards. The postoperative patellar apprehension test was all negative. The average Lysholm score was （ 63. 1±9. 1 ） points preoperatively, and （ 87. 1±6. 4 ） points postoperatively. The improvement of postopertive scores was statistically significant （t = -21.7, P 〈0. 05） , compared with preoperative scores. According to Insall efficacy standards, the excellent rate was 85.7%. Conclusions The results of reconstructing the MPFL with free tendon in recurrent patellar dislocation are satisfactory.