大收肌腱重建内侧髌股韧带治疗青少年复发性髌骨脱位

摘要

Objective To investigate the surgical method and clinical curative effects of medial patellofemoral ligament (MPFL)reconstruction with great adductor muscular tendon transposition in the treatment of teenagers recurrent patellar dislo-cation. Methods From April 2011 to July 2013,nineteen patients(20 knees)with teenagers' recurrent patellar dislocation, age from 14 to 18 years old and had 2 to 4 times patellar dislocation,were admitted to our hospital. All the patients were treated with the surgery of great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. Furthermore,the knee function of these patients were evaluated with Lysholm grading and Insall standard before the surgery and after the surger-y. Results All the patients were followed up for 6 ~ 36 months with anaverage of 22 months,the patellar stability was restored and the recurrence of patellar dislocation was none in all cases. According to Lysholm,the average score before and after the surgery were 61. 6 ± 4. 0 and 93. 4 ± 3. 4(P < 0. 01)respectively. With Insall standard,the postoperative effects were as fol-lows:13 cases(13 knees)were excellent,4 cases(5 knees)were good and 2 cases(2 knees)were ordinary. Overall,the good rate was 90. 0% . Conclusion The surgery of treating RDP through the reconstruction of MPFL with great adductor mus-cular tendon transposition has the advantages of reliable effects,small incision,easy operation,quick recovery and the effective-ness of preventing the recurrence of the patellar dislocation. Therefore,it is worth clinical application.%目的：探讨大收肌腱转位重建内侧髌股韧带（medial patello femoral ligament，MPFL）治疗青少年复发性髌骨脱位（recurrent dislocation of patella，RDP）的手术方法和临床疗效。方法2011年4月至2013年7月，本院收治复发性髌骨脱位19例（20膝），其中男4例4膝，女15例16膝，年龄14~18岁，平均15.2岁。脱位次数2~4次。所有患者均行大收肌腱转位重建内侧髌股韧带术，术前、术后采用 Lysholm 评分及 Insall 标准评价膝关节功能。结果所有患者均获得随访，随访时间6~36个月，平均22个月。术后髌股关节稳定，无髌骨脱位再次发生。Lysholm 评分术前平均（61.6±4.0）分，术后（93.4±3.4）分（P <0.01）。术后疗效按 Insall 标准进行评价，优13例（13膝），良4例（5膝），可2例（2膝）。优良率为90.0%（18/20）。结论采用大收肌腱转位重建 MPFL 手术治疗 RDP 疗效可靠，手术创伤小，操作简单，康复快，可有效防止髌骨脱位的复发，值得临床推广。