青少年髌骨脱位内侧髌股韧带修复与重建比较△（开放获取）

Repair versus reconstruction of medial patellofemoral ligament for primary patellar dislocation in adolescents

摘要:

[目的] 对比修复与重建内侧髌股韧带 （medial patellofemoral ligament, MPFL） 治疗青少年初次创伤性髌骨脱位的疗效。[方法] 2019 年 6 月—2022 年 6 月治疗初次创伤性髌骨脱位共 26 例 （26 膝），根据医患沟通结果，12 例采用锚钉修复 MPFL，另外 14 例采用大收肌腱双束重建 MPFL。比较两组临床及影像资料。[结果] 患者均顺利完成手术，无神经、血管损伤。修复组手术时间显著短于重建组 [(54.9±7.8) min vs (84.2±8.9) min, P＜0.001]。随访时间平均 （31.0±11.6） 个月。与术前相比，末次随访两组 VAS 评分显著减少 （P＜0.05），Kujala 评分、膝 ROM 显著增加 （P＜0.05）。相应时间点，两组间 VAS 评分、 Kujala 评分、膝 ROM 差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访两组髌骨倾斜角、髌外移、胫骨结节股骨滑车沟距离均显著减小（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]MPFL 修复或重建治疗青少年初次创伤性髌骨脱位短期疗效相近。

Abstract:

[Objective] To compare clinical outcomes of repair verus reconstruction of medial patellofemoral ligament (MPFL) for primary traumatic patellar dislocation in adolescents. [Methods] From June 2019 to June 2022, a total of 26 patients (26 knees) were surgically treated for primary traumatic patellar dislocation. According to doctor-patient communication, 12 adolescents were treated by MPFL repair with suture anchors, while other 14 patients were treated by double-bundle reconstruction of MPFL with adductor magnus tendon. The clinical and imaging data of the two groups were compared. [Results] All patients were successfully operated without nerve or vascular injuries. The repair group consumed significantly shorter operation time than the reconstruction group [(54.9±7.8) min vs (84.2±8.9) min, P＜ 0.001]. The patients were followed up for an average of (31.0±11.6) months. Compared with those preoperatively, the VAS score was significantly decreased (P＜0.05), whereas the Kujala score and knee ROM significantly increased at the last follow-up (P＜0.05), however, which proved not significantly different at any points accordingly between the two groups (P＞0.05). In terms of imaging, compared with those preoperatively, the patellar inclination angle, patellar displacement and tibial tuberosity-trochlear groove (TT-TG) significantly decreased in the two groups at the last follow-up (P＜0.05), and there were no statistically significant differences in the above imaging indicators between the two groups at any corresponding time points (P＞0.05). [Conclusion] MPFL repair or reconstruction in the treatment of adolescents primary traumatic patellar dislocation has similar short-term clinical efficacy