股骨滑车发育不良对内侧髌股韧带重建术的影响△

Influence of femoral trochlea dysplasia on medial patellofemoral ligament reconstruction

摘要:

［目的］ 探讨内侧髌股韧带 （medial patellofemoral ligment, MPFL） 重建治疗伴股骨滑车发育不良 （femoral trochlear dysplasia, FTD） 的复发性髌骨脱位 （recurrent patellar dislocation, RPD） 的中期临床效果。［方法］ 回顾性分析 2013 年 1 月— 2016 年 12 月，22 例（26 膝）伴有 FTD 的 RPD 关节镜辅助下 MPFL 双束重建术患者的临床资料。按 Dejour 分型，将患者分为 FTD 轻度组 （Dejour 分型 A 型） 10 例，重度组 （Dejour 分型 B、C、D 型） 12 例。比较两组围手术期、随访与影像资料。［结果］两组患者均未出现髌骨脱位复发，无严重并发症。两组手术时间、切口长度、术中失血量、透视次数、住院时间的差异均无统计学意义 （P>0.05）。平均随访 （5.23±0.86） 年。两组患者完全负重活动时间差异无统计学意义 （P>0.05），随时间推移， 两组 VAS 评分显著减少（P<0.05），而 Kujala 评分、Lysholm 评分、Tegner 评分显著增加（P<0.05）。相应时间点，两组间上述评分的差异均无统计学意义（P>0.05）。与术前相比，末次随访时两组患者 TT-TG 值、股骨外侧滑车倾角、股骨内侧滑车与外侧滑车比、股骨滑车深度、Caton-Deschamps 指数均无显著变化（P>0.05）。［结论］MPFL 重建治疗伴 FTD 的 RPD 中期疗效满意；FTD 对临床结果的影响不明显。

Abstract:

[Objective] To investigate the mid-term clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction for re- current patellar dislocation (RPD) accompanied with femoral trochlear dysplasia (FTD) . [Methods] A retrospective study was conducted on 22 patients (26 knees) who received double-bundle MPFL reconstruction for RPD accompanied with FTD from January 2013 to December 2016 in our hospital. According to Dejour classification preoperatively, 10 patients were fall in the mild FTD group, while the remaining 12 patients were in the severe FTD group. The perioperative, follow-up and imaging data were compared between the two groups. [Results] All the patients in both groups were operated on successfully without serious complications. There were no significant differences in operative time, incision length, intraoperative blood loss, fluoroscopy times and hospital stay between the two groups (P＞0.05) . The follow-up period lasted for (5.23±0.86) years on an average. There was no significant difference in the time to resume complete weight-bearing activity be- tween 2 groups (P＞0.05) . The VAS scores decreased significantly (P＜0.05) , while Kujala score, Lysholm score and Tegner score were sig- nificantly increased in both groups over time (P＜0.05) . At any corresponding time points, there was no statistically significant difference in the above scores between the two groups (P＞0.05) . Radiographically, no significant changes in TT-TG, lateral trochlear inclination, trochle- ar facet asymmetry, trochlear depth and Caton-Deschamps index were found in both groups at the latest follow-up compared with those pre- operatively (P＞0.05) . [Conclusion] MPFL reconstruction does achieve satisfactory mid-term clinical outcomes for RPD, which is not im- pacted remarkably by FTD.