金玉林　张伟　李小鹏

【摘要】 目的：探討关节镜辅助下自体肌腱重建内侧髌股韧带治疗复发性髌骨脱位的临床疗效。方法：回顾性分析2014年6月-2016年3月在本科收治复发性髌骨脱位患者19例，手术采用关节镜下外侧副韧带松解，取同侧腘绳肌腱重建内侧髌股韧带。术后正规关节功能锻炼，评估术后关节疼痛、无力、髌骨倾斜实验、恐惧实验等变化，术后关节功能改善采用Lyshom和Kujala膝关节评分及Insall疗效标准进行评价。结果：所有患者术后均获得随访，术前膝关节Lyshom评分为（68.3±1.4）分，术后（95.4±1.8）分；Kujala评分术前（63.2±2.3）分，术后（92.4±2.5）分，手术前后比较差异均有统计学意义（P<0.05）。Insall疗效标准，优良率达94.7%。所有患者术后关节疼痛、无力症状得到明显改善，髌骨倾斜、恐惧实验阴性，关节无再次脱位发生。结论：在把握适应证前提下，关节镜辅助内侧髌骨韧带重建治疗复发性髌骨脱位是一种不错的手术方法。关节镜下外侧副韧带的松解、术中双股髌骨韧带重建、髌骨端金属锚钉固定、屈膝关节60°位股骨端固定增加了髌骨的稳定性，提高了手术的可靠性。

【关键词】 复发性髌骨脱位； 自体肌腱； 内侧髌股韧带； 重建； 关节镜

Analysis of Autologous Tendon Reconstruction of the Medial Patellofemoral Ligament for the Treatment of Recurrent Patellar Dislocation Clinical Curative Effect/JIN Yu-lin，ZHANG Wei，LI Xiao-peng.//Medical Innovation of China，2016，13（31）：145-148

【Abstract】 Objective：To investigate the clinical efficacy of arthroscopic autologous tendon reconstruction of the medial patellofemoral ligament for the treatment of recurrent patellar dislocation.Method：Retrospective analysis 19 cases with recurrent patellar dislocation in our department，they were selected from June 2014 to March 2016.Surgery with arthroscopic lateral collateral ligament release， ipsilateral hamstring tendon autograft for the reconstruction of the medial patellofemoral ligament.Postoperative they were given normal joint function exercise to assess postoperative pain，weakness， patellar tilt test and fear the changes.Postoperative joint function improve was evaluated by Lyshom and Kujala knee score and Insall standard.Result：All patients were followed up，preoperative knee score Lyshom for （68.3±1.4）score，postoperative was （95.4±1.8） score；Kujala score preoperative was（63.2±2.3） score and postoperative was （92.4±2.5） score， the differences were statistically significant（P<0.05）.Insall curative effect standard， the excellent and good rate of 94.7%.All the patients after joint pain and weakness symptoms improved significantly，patellar tilt， fear the negative，no joint again dislocation.Conclusion：In to control the disease under the premise that arthroscopic medial patellofemoral ligament reconstruction in the treatment of recurrent patellar dislocation is a good surgery method. Arthroscopic lateral collateral ligament release， intraoperative double patellar ligament reconstruction， patella end metal anchor nail fixed， flexion of the knee joint 60° with a femoral side fixation increased the patellar stability and improve the reliability of the operation.

【Key words】 Recurrent patellar dislocation； Autologous tendon； Medial patellofemoral ligament； Reconstruction； Arthroscopic

First-authors address：Peoples Hospital of Puer City，Puer 665000，China

doi：10.3969/j.issn.1674-4985.2016.31.042

復发性髌骨脱位在临床上多见，尤其在青少年人群中，文献[1]报道髌骨脱位率为0.058‰。脱位常发生于创伤引起的严重首次髌骨脱位之后，且常伴有一种或多种潜在解剖异常。非手术治疗再脱位率为15%～71%[2]，手术治疗该脱位的方法有100多种，大体上可分为松解紧张的外侧副韧带、伸膝装置近端重排、伸膝装置远端重排、伸膝装置远近端重排、髌骨切除并伸膝装置重排等，传统手术治疗复发性髌骨脱位再脱位率高。近年来，内侧髌股韧带不全被证实是导致髌骨复发性脱位的主要静力因素，重建内侧髌股韧带治疗髌骨复发性脱位效果确切。本科自2014年6月-2016年3月采用关节镜辅助下外侧副韧带松解、取自体肌腱重建内侧髌股韧带治疗复发性髌骨脱位患者19例，取得良好临床疗效，现报道如下。……