急性髌骨脱位两种技术修复膝内侧支持带的比较△

Comparison of two suture anchor techniques for repair of medial patellofemoral ligament in acute patellar dislocation

摘要:

[目的] 比较带线锚定绕髌折叠紧缩缝合与直接缝合髌股内侧韧带带治疗髌骨侧损伤型急性髌骨脱位的临床疗效。[方法] 回顾分析2015 年10 月—2021 年5 月采用带线锚钉缝合治疗的内侧支持带髌骨侧损伤型急性髌骨脱位34 例患者的临床资料。根据医患沟通结果，18 例采用绕髌折叠紧缩缝合（绕髌组），16 例采用直接原位缝合（直接组）。比较两组围手术期、随访及影像结果。[结果] 两组患者均顺利完成手术，两组手术时间、切口长度、术中失血量、下地行走时间及住院时间的差异均无统计学意义（P＞0.05）。所有患者均获随访，随访时间平均（4.3±1.1） 年，两组完全负重活动时间的差异无统计学意义（P＞0.05），与术前相比，末次随访时，两组患者膝关节VAS 评分、IKDC 评分、Kujala 评分和ROM 均显著改善。相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。随访过程中，绕髌组患者无再脱位出现，相比之下，直接组2 例患者（2/16） 出现再脱位。影像方面，与术前相比，末次随访时，两组患者PT、PS 均显著减少（P＜0.05），相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 两种带线锚钉修复方式治疗内侧髌股韧带髌骨侧损伤型急性髌骨脱位临床疗效满意，相比而言，绕髌骨紧缩缝合修复方式在防止髌骨再脱位方面更具优势。

Abstract:

[Objective] To compare the clinical efficacy of folded repair (FR) and direct repair (DR) of the medial patellofemoral liga-ments (MPFL) with suture anchors for acute patellar dislocation with patellar side injury. [Methods] A retrospective study was conductedon 34 patients who received MPFL repair with suture anchors for acute patellar dislocation from October 2015 to May 202. According to thedoctor-patient discussion, 18 patients underwent FR, while the remaining 16 patients underwent DR. The documents regarding to perioper-ative period, follow-up and imaging were compared between the two groups. [Results] All the patients in both groups got operation per-formed successfully with no statistically significant differences in terms of operation time, incision length, intraoperative blood loss, postop-erative walking time and hospital stay between the two groups (P＞0.05). All of them were followed up for an average of (4.3±1.1) years, andthere was no significant difference in time to resume full weight-bearing activity between the two groups (P＞0.05). The VAS score for anteri-or knee pain, IKDC and Kujala scores, as well as knee flexion extension range of motion (ROM) were significantly improved in both groupsat the last follow-up compared with those preoperatively (P＜0.05), whereas which were not of statistically significant differences betweenthe two groups at any time points accordingly (P＞0.05). During follow-up, no re-dislocation occurred in anyone of the FR group, whereas 2patients (2/16) of re-dislocation happened in the DR group. Radiographically, the patellar tilt (PT) and patellar shift (PS) were significantlyreduced in both groups at the last follow-up compared with pre-operation (P＜0.05), however, there were no statistically significant differ-ences in the abovementioned imaging measurements between the two groups in any matching time points (P＞0.05). [Conclusion] The clini-cal outcomes of the two kinds of suture-anchor repair is satisfactory and comparable for acute patellar dislocation due to patellar side inju-ry. However, the folded repair might take a advantage of preventing patellar re-dislocation over the direct repair.