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[1]陳犖,顧圣華,章培峰,等.關(guān)節(jié)鏡輔助定位股骨隧道重建內(nèi)側(cè)髕股韌帶治療復(fù)發(fā)性髕骨脫位的臨床研究[J].中醫(yī)正骨,2021,33(07):11-16.
　CHEN Luo,GU Shenghua,ZHANG Peifeng,et al.A clinical study of femoral tunnel positioning assisted by arthroscopy in medial patellofemoral ligament reconstruction for treatment of recurrent patellar dislocation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(07):11-16.
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關(guān)節(jié)鏡輔助定位股骨隧道重建內(nèi)側(cè)髕股韌帶治療復(fù)發(fā)性髕骨脫位的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年07期
頁碼:
11-16
欄目:
臨床研究
出版日期:
2021-07-20

文章信息/Info

Title:
A clinical study of femoral tunnel positioning assisted by arthroscopy in medial patellofemoral ligament reconstruction for treatment of recurrent patellar dislocation
作者:
陳犖; 顧圣華; 章培峰; 周建烽
(諸暨市第二人民醫(yī)院,浙江 諸暨 311811)
Author(s):
CHEN Luo; GU Shenghua; ZHANG Peifeng; ZHOU Jianfeng
The Second People’s Hospital of Zhuji city,Zhuji 311811,Zhejiang,China
關(guān)鍵詞:
髕骨脫位;  關(guān)節(jié)鏡檢查;  修復(fù)外科手術(shù);  內(nèi)側(cè)髕股韌帶;  股骨隧道
Keywords:
patellar dislocation;  arthroscopy;  reconstructive surgical procedures;  medial patellofemoral ligament;  femoral tunneling
摘要:
目的:探討關(guān)節(jié)鏡輔助定位股骨隧道重建內(nèi)側(cè)髕股韌帶(medial patellofemoral ligament,MPFL)治療復(fù)發(fā)性髕骨脫位的臨床療效和安全性。方法:對80例復(fù)發(fā)性髕骨脫位患者的病例資料進行回顧性分析,根據(jù)MPFL重建術(shù)中股骨隧道定位方式的不同分為關(guān)節(jié)鏡定位組(采用關(guān)節(jié)鏡輔助定位,42例)和觸摸定位組(采用觸摸股骨骨性標(biāo)志定位,38例)。比較2組患者的手術(shù)時間、切口長度、術(shù)中出血量、股骨隧道等距隧道率、髕骨角、膝關(guān)節(jié)Lysholm評分、美國膝關(guān)節(jié)協(xié)會(the American Knee Society,AKS)評分及并發(fā)癥發(fā)生率。結(jié)果:①一般結(jié)果。關(guān)節(jié)鏡定位組手術(shù)時間、手術(shù)切口均短于觸摸定位組,術(shù)中出血量少于觸摸定位組[(65.4±6.4)min,(94.5±7.8)min,t=5.151,P=0.012;(4.1±0.3)cm,(8.2±1.8)cm,t=8.893,P=0.001;(149.7±24.5)mL,(207.2±30.3)mL,t=9.384,P=0.000]。2組患者隨訪時間12～18個月,中位數(shù)14個月。②股骨隧道等距隧道率和髕骨角。關(guān)節(jié)鏡定位組等距點距離1.52～5.14 mm(中位數(shù)3.25 mm),股骨隧道均為等距隧道; 觸摸定位組等距點距離5.33～9.17 mm(中位數(shù)7.32 mm),股骨隧道為等距隧道者12例; 關(guān)節(jié)鏡定位組股骨隧道等距隧道率高于觸摸定位組(P=0.000)。關(guān)節(jié)鏡定位組髕骨角大于觸摸定位組(12.2°±4.1°,10.3°±3.9°,t=9.482,P=0.000)。③膝關(guān)節(jié)評分。術(shù)前2組患者膝關(guān)節(jié) Lysholm評分、AKS評分組間比較,差異均無統(tǒng)計學(xué)意義[(38.07±1.48)分,(37.94±1.53)分,t=8.682,P=0.189;(43.22±4.77)分,(42.74±4.68)分,t=9.358,P=0.248]; 末次隨訪時,關(guān)節(jié)鏡定位組膝關(guān)節(jié)Lysholm評分、AKS評分均高于觸摸定位組[(95.47±0.49)分,(90.23±0.51)分,t=1.673,P=0.028;(96.25±0.59)分,(91.47±0.73)分,t=1.248,P=0.002]。④并發(fā)癥發(fā)生率。術(shù)后關(guān)節(jié)鏡定位組出現(xiàn)關(guān)節(jié)腔積血1例,觸摸定位組出現(xiàn)切口感染2例、髕骨再脫位1例; 2組患者并發(fā)癥發(fā)生率比較,差異無統(tǒng)計學(xué)意義(χ2=0.380,P=0.538)。結(jié)論:關(guān)節(jié)鏡輔助定位股骨隧道重建MPFL治療復(fù)發(fā)性髕骨脫位,與用手觸摸骨性標(biāo)志定位股骨隧道相比,切口小、手術(shù)時間短、術(shù)中出血少,股骨隧道定位更準(zhǔn)確,髕骨復(fù)位更好,更有利于膝關(guān)節(jié)功能的恢復(fù),但兩者的安全性相當(dāng)。
Abstract:
To explore the clinical curative effects and safety of femoral tunnel(FT)positioning assisted by arthroscopy in medial patellofemoral ligament(MPFL)reconstruction for treatment of recurrent patellar dislocation(RPD).Methods:The medical records of 80 patients who underwent MPFL reconstruction for treatment of RPD were analyzed retrospectively.The patients were divided into 2 groups according to FT positioning methods.The arthroscopic-assisted positioning method was used in 42 patients(AA positioning group),while palpation(palpating femoral bony landmarks)positioning method was used in 38 patients(palpation positioning group).The operative time,incision length,intraoperatve blood loss,FT isometric tunnel rate,patella angle,Lysholm knee score,the American Knee Society(AKS)score and complication incidence were compared between the 2 groups.Results:The operative time and incision length were shorter and the intraoperatve blood loss was less in AA positioning group compared to palpation positioning group(65.4±6.4 vs 94.5±7.8 minutes,t=5.151,P=0.012; 4.1±0.3 vs 8.2±1.8 cm,t=8.893,P=0.001; 149.7±24.5 vs 207.2±30.3 mL,t=9.384,P=0.000).All patients in the 2 groups were followed up for 12-18 months with a median of 14 months.The isometric point distance was 1.52-5.14 mm with a median of 3.25 mm,and all of the FTs were isometric tunnels in AA positioning group; while,in palpation positioning group,the isometric point distance was 5.33-9.17 mm with a median of 7.32 mm,and the isometric tunnels were found in 12 patients.The FT isometric tunnel rate was higher in AA positioning group compared to palpation positioning group(P=0.000),and the patella angles were greater in AA positioning group in contrast to palpation positioning group(12.2±4.1 vs 10.3±3.9 degrees,t=9.482,P=0.000).There was no statistical difference in Lysholm knee scores and AKS scores between the 2 groups before the surgery(38.07±1.48 vs 37.94±1.53 points,t=8.682,P=0.189; 43.22±4.77 vs 42.74±4.68 points,t=9.358,P=0.248).The Lysholm knee scores and AKS scores were higher in AA positioning group compared to palpation positioning group at last follow-up(95.47±0.49 vs 90.23±0.51 points,t=1.673,P=0.028; 96.25±0.59 vs 91.47±0.73 points,t=1.248,P=0.002).After the surgery,the articular cavity hematocele(1 case)was found in AA positioning group; while incision infection(2 cases)and patellar redislocation(1 case)were found in palpation positioning group.There was no statistical difference in complication incidences between the 2 groups(χ2=0.380,P=0.538).Conclusion:Compared to palpation positioning in MPFL reconstruction for treatment of RPD,FT positioning assisted by arthroscopy has such advantages as smaller incision,shorter operative time,less intraoperative blood loss and more accurate FT positioning,and it can be more conducive to patellar reduction and knee function recovery,while the two methods are similar to each other in the safety.

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更新日期/Last Update: 1900-01-01