目的:探讨关节镜辅助下解剖重建内侧髌股韧带治疗复发性髌骨脱位的手术方法及疗效.方法:选取2010年3月～2015年8月因复发性髌骨脱位接受手术治疗的患者20例,其中男6例,女14例;年龄19～34岁,平均(23.6±4.54)岁;右膝15例,左膝5例.19例有明确膝关节外伤史.采用自体半腱肌肌腱移植配合关节镜下内侧髌股韧带双束解剖重建、外侧支持带松解的方法治疗,并应用Lysholm和Kujala评分评价膝关节功能.结果:所有患者术后均获得随访,平均随访时间(22±5.42)个月 (12～30个月).Lysholm评分术前为(60.05±3.53)分,术后为(92.80±1.74)分,两者比较差异有统计学意义(t=-42.680,P<0.01).Kujala主观评分术前为(59.95±3.52)分,术后为(93.35±2.66)分,两者比较差异有统计学意义(t=-53.375,P<0.01).所有患者均未再出现脱位情况,髌骨外推及恐惧试验均为阴性.结论:关节镜辅助下行双束解剖重建内侧髌骨韧带是治疗复发性髌骨脱位的有效方法之一,且具有微创、安全、针对性强、术后功能恢复快等优点.%Objective:To assess the procedure and efficacies of anatomical medial patellofemoral ligament(MPFL) reconstruction for the treatment of recurrent patellar dislocation assisted with arthroscopy.Methods: Twenty patients with recurrent patellar dislocation treated between March 2010 and August 2015 were enrolled in this study.Of the patients,6 were males and 14 females.The patients' age ranged from 19 to 34 years[mean:(23.6±4.54)years].Fifteen patients were associated with injury at the right knee,and 5 in the left.Nineteen had had a history of obvious knee injury.Surgical procedure included autogenous semitendinosus tendon transplantation combined with arthroscopic-assisted double-bundle anatomical medial patellofemoral ligament reconstruction and lateral retinacular release.The knee functions following surgery were evaluated using the Lysholm and Kujala scoring systems.Results: All patients were followed up for 12 to 30 months[mean:(22±5.42)months].Preoperative and postoperative Lysholm and Kujala scores were 92.80±1.74 and 59.95±3.52,92.80±1.74 and 93.35±2.66,respectively,(t=-42.680,P<0.01;t=-53.375,P<0.01).No recurrent dislocation occurred,and all patients showed negative response by apprehension test.Conclusion: Arthroscopic-assisted double-bundle anatomical reconstruction of the medial patellar ligament appears one of the effective procedures for recurrent patellar dislocation,and this technique has series of advantages,including minimal invasion,safety,specificity and early recovery of the joint function.
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