复发性髌骨脱位胫骨结节截骨移位内侧髌股韧带重建

Tibial tubercle osteotomy and medial patellofemoral ligament reconstruction for recurrent patellar dislocation

摘要:

[目的] 探讨胫骨结节截骨移位术联合双隧道等长重建内侧髌股韧带 （medial patellofemoral ligament, MPFL） 治疗复发性髌骨脱位的临床疗效。[方法]回顾性分析 2017 年 5 月—2022 年 5 月本院收治的 20 例复发性髌骨脱位的患者资料，均行双隧道等长重建 MPFL 联合胫骨结节截骨移位。评估临床及影像结果。[结果] 患者均顺利完成手术，手术时间 （65.3±6.7） min，随访时间平均（12.2±0.7）个月，与术前相比，术后 12 个月患者 Lysholm 评分 [(53.7±9.9), (86.5±6.0), P＜0.001]、Kujala 评分 [(55.5±6.3), (83.7±7.9), P＜0.001]、IKDC 评分 [(54.6±8.7), (86.7±6.9), P＜0.001] 均显著增加。至末次随访时，所有患者均无再脱位发生。影像方面，与术前相比，术后 12 个月，患者髌骨适合角（patellofemoral congruence angle, PCA）[(28.2±4.4)°, (13.3±2.6)°, P＜ 0.001]、髌骨倾斜角 （patella title angle, PTA） [(23.1±4.8)°, (8.9±2.9)°, P＜0.001]、胫骨结节-股骨滑车间沟距离 （tibial tubercletrochlear groove distance, TT-TG） [(22.1±1.74) mm, (11.9±1.9) mm, P＜0.001]、股四头肌角 （quadricep angle, Q 角） [(23.1±2.4)°, (15.1±2.6)°, P＜0.001] 均显著减小，但髌股关节软骨厚度无明显变化（P＞0.05）。[结论]双隧道等长重建 MPFL 联合胫骨结节截骨移位术治疗复发性髌骨脱位的临床疗效显著。

关键词:复发性髌骨脱位;胫骨结节截骨移位术;内侧髌股韧带;等长重建

Abstract:

[Objective] To investigate the clinical efficacy of tibial tuberosity osteotomy combined with double-tunnel isometric reconstruction of medial patellofemoral ligament (MPFL) in the treatment of recurrent patellar dislocation. [Methods] A retrospective study was conducted on 20 patients who received surgical treatment for recurrent patellar dislocation in our hospital from May 2017 to May 2022. All of them underwent double-tunnel isometric reconstruction MPFL combined with tibial tuberosity osteotomy. The clinical and imaging data were evaluated. [Results] All the patients had operation performed successfully with operation time of (65.3±6.7) min, and were followed up for (12.2±0.7) months. Compared with those before operation, the Lysholm score [(53.7±9.9), (86.5±6.0), P＜0.001], Kujala score [(55.5±6.3), (83.7±7.9), P＜0.001] and IKDC scores [(54.6±8.7), (86.7±6.9), P＜0.001] were significantly increased 12 months postoperatively. No further dislocation occurred in anyone of them utill the last follow-up. Radiographically, the patellofemoral congruence angle (PCA) [(28.2±4.4)°, (13.3±2.6)°, P＜0.001], patella title angle (PTA) [(23.1±4.8)°, (8.9±2.9)°, P＜0.001], tibial tubercle-trochlear groove distance (TT-TG) [(22.1± 1.74) mm, (11.9±1.9) mm, P＜0.001] and quadricep angle (Q Angle) [(23.1±2.4)°, (15.1±2.6)°, P＜0.001] decreased significantly 12 months after operation compared with those preoperatively, but the patellofemoral cartilage thickness remained unchanged (P＞0.05). [Conclusion] The tibial tuberosity osteotomy combined with double-tunnel isometric reconstruction of MPFL is an effective treatment for recurrent patellar dislocation.

Key words:recurrent patellar dislocation; tibial tuberosity osteotomy; medial patellofemoral ligament; isometric reconstruction