标题：关节镜辅助MPFL重建联合胫骨结节内移截骨治疗复发性髌骨脱位临床观察

      作者：卢小斌 1，王勇 1，彭生元 2    1.商洛市职业技术学院附属医院骨科，陕西 商洛 726000；2.榆林市中医医院骨科，陕西 榆林 719000

      卷次： 2020年31卷3期

      【摘要】 目的 分析关节镜辅助内侧髌骨股骨韧带(MPFL)重建联合胫骨结节内移截骨治疗复发性髌骨脱位的临床疗效，为患者的临床诊疗提供指导。方法 选取2016年1月至2018年1月在商洛市职业技术学院附属医院骨科接受治疗的复发性髌骨脱位45例进行研究。所有患者均给予关节镜辅助MPFL重建联合胫骨结节内移截骨治疗。比较患者手术前后的髌股适合角(CA)、胫骨结节-股骨滑车间距(TT-TG值)、髌骨倾斜角(PTA)及髌股关节功能评分(Kujala)、膝关节功能评分表(Lysholm)、膝关节主观评价表(IKDC)评分。1年后对患者进行回访，记录髌骨再次脱位情况。结果 患者手术后的CA、TT-TG值、PTA分别为(12.73±2.32)°、(10.64±1.73) mm、(15.82±2.12)°，明显小于手术前的(26.06±5.25)°、(25.45±3.04) mm、(24.56±3.57)°，差异均有统计学意义(P<0.05)；手术后，患者的Kujala评分、Lysholm评分、IKDC评分分别为(89.75±6.27)分、(86.64±5.59)分、(87.82±7.02)分，明显高于手术前的(50.36±7.75)分、(52.45±6.54)分、(51.56±7.59)分，差异均有统计学意义(P<0.05)；1年后，无患者再次脱位。结论 关节镜辅助MPFL重建联合胫骨结节内移截骨治疗复发性髌骨脱位临床效果显著，其不仅能有效缓解患者临床症状，改善膝关节的稳定性，促进患者膝关节功能恢复，而且还能防止脱位再复发，值得临床推广应用。
      【关键词】 复发性髌骨脱位；关节镜；内侧髌骨股骨韧带重建；胫骨结节内移截骨；疗效
      【中图分类号】 R681.8 【文献标识码】 A 【文章编号】 1003—6350（2020）03—0326—04

Clinical study of recurrent patellar dislocation treated with arthroscopically assisted MPFL reconstructioncombined with tibial tuberosity and internal osteotomy.
LU Xiao-bin 1, WANG Yong 1, PENG Sheng-yuan 2. 1.Department of Orthopaedics, the Affiliated Hospital of Shangluo Vocational and Technical College, Shangluo 726000, Shaanxi,CHINA; 2. Department of Orthopaedics, the Chinese Medicine Hospital of Yulin City, Yulin 719000, Shaanxi, CHINA
【Abstract】 Objective To analyze the clinical effect of arthroscopically assisted medial patellofemoral ligament(MPFL) reconstruction combined with tibial tuberosity and osteotomy for the treatment of recurrent patellar dislocation,and provide guidance for clinical diagnosis and treatment. Methods From January 2016 to January 2018, 45 patientswith recurrent dislocation of patella who admitted to Department of Orthopaedics, the Affiliated Hospital of ShangluoVocational and Technical College were selected for this study. All patients were treated with arthroscopic assisted MPFLreconstruction combined with tibial tuberosity. The patellofemoral angle (CA), tibial tubercle trochlear groove distance(TT-TG), patella tilt angle (PTA), the scores of Kujala, Lysholm and International Knee Documentation Committee (IK-DC) evaluation were compared before and after operation. One year later, the patients were followed up to record there-dislocation of patella. Results The postoperative CA, TT-TG and PTA were (12.73 ± 2.32)° , (10.64 ± 1.73) mm,(15.82±2.12)° respectively, which were significantly lower than corresponding (26.06±5.25)°, (25.45±3.04) mm, (24.56±3.57) ° before surgery (all P<0.05); after operation, the Kujala score, Lysholm score, and IKDC score of the patientswere (89.75±6.27) points, (86.64±5.59) points, (87.82±7.02) points, respectively, which were significantly higher thancorresponding (50.36±7.75) points, (52.45±6.54) points, (51.56±7.59) points (all P<0.05); after one year, no patients dis-located again. Conclusion Arthroscopic-assisted MPFL reconstruction combined with tibial tuberosity has a significantclinical effect in the treatment of recurrent dislocation of the patella. It can not only effectively alleviate the clinicalsymptoms of patients, improve the stability of the knee joint, promote the recovery of the knee joint function of patients,but also prevent the recurrence of dislocation. It is worthy of clinical application.
      【Key words】 Recurrent dislocation of patella; Arthroscopy; Medial patellofemoral ligament (MPFL) reconstruc-tion; Tibial tubercle osteotomy; Curative effect