急性髌骨脱位镜下髌内侧支持带修复术△

Arthroscopic repair of medial patellofemoral ligament for acute patellar dislocation

摘要:

［目的］ 介绍镜下内侧髌股韧带 （medial patellofemoral ligament, MPFL） 髌骨止点撕裂修复术的手术技术和初步临床效果。［方法］2015 年 5 月—2019 年 9 月，对 30 例初次急性髌骨脱位（acute patellar dislocation, APD）患者行镜下修复术。于髌骨内侧缘置入带线锚钉，平行髌骨内侧缘内侧用腰穿针均等穿刺皮肤至关节腔，将带环过线导丝从腰穿针引入将锚钉缝线引出皮肤外，收紧后视髌骨轨迹适度松解外侧支持带，最后打结。［结果］所有患者均顺利完成手术，术中无神经、血管损伤等严重并发症。平均随访时间（26.10±9.70）个月，末次随访时，患膝关节活动度正常，无复发性髌骨脱位，无明显关节僵硬和功能障碍等。末次随访时 Lysholm 评分、髌骨倾斜角（patellar tilt angle, PTA）和髌股适合角（congruence angle, CA）均较术前显著改善（P<0.05）。［结论］镜下髌 MPFL 止点修复治疗 APD，能恢复髌股关节稳定性和功能，是一种有效的治疗方法。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic repair of medial patellofemo- ral ligament (MPFL) torn on patellar attachment secondary to acute patellar dislocation (APD) . [Methods] From May 2015 to September 2019, 30 patients with MPFL torn on patellar attachment secondary to APD received aforesaid arthroscopic repair. Two suture anchors were inserted on the medial edge of the patella, and then lumbar puncture needles punctured percutaneously, to pass through the femoral side MP- FL parallelly to the joint cavity. After that, the sutures attached on anchors were introduced out the skin on the medial side by loops through the lumbar puncture needles. Under arthroscopic vision, the sutures were tightened, and the patella track was evaluated, lateral retinacular release was added if necessary. As proper patella track achieved, the sutures were tied at last. [Results] All patients were successfully operat- ed on without serious complications such as nerve and vascular injury, and followed up for (26.10±9.70) months on average. By the time of the latest follow-up, all the patients got normal range of motion of the knee with no recurrent patellar dislocation and stiffness or dysfunction of the knee. The Lysholm score, patellar tilt angle (PTA) and patellofemoral congruence angle (CA) improved significantly in the latest fol- low-up compared with those preoperatively (P＜0.05) . [Conclusion] This arthroscopic repair of MPFL torn on patellar attachment secondary to acute patellar dislocation does restore the patellofemoral stability and function, and is an effective treatment.