摘要
目的 比较髌骨侧贴面固定与隧道固定重建内侧髌股韧带(MPFL)治疗青少年复发性髌骨脱位的早期疗效.方法 回顾性分析2020年1月至2023年1月新疆医科大学第六附属医院小儿骨科收治的50例复发性髌骨脱位患者资料.男12例,女38例;年龄(15.0±0.9)岁;左侧23例,右侧27例;术前脱位次数为(2.5±0.9)次.根据手术方式不同将患者分为2组:贴面组(行髌骨侧贴面固定重建MPFL)25例;隧道组(行髌骨侧隧道固定重建MPFL)25例.比较末次随访时两组患者的Kujala评分、Lysholm评分、外侧髌股角(LPFA)、髌股适合角(CA)、髌骨倾斜角(PTA)、髌骨外移度(LPT).结果 贴面组和隧道组患者术前一般资料比较差异均无统计学意义(P＞0.05),具有可比性.50例患者术后获(24.1±5.1)个月随访.术后贴面组和隧道组患者均未出现髌骨骨折、关节屈伸功能受限等并发症;末次随访时两组患者均未出现再次髌骨脱位.末次随访时贴面组患者Kujala评分、Lysholm评分、LPFA、CA、PTA、LPT 分别为(87.8±4.3)分、(88.3±4.7)分、9.5°±1.1°、10.8°±1.4°、9.6.±1.0°、(9.2±1.3)mm,以上项目隧道组患者分别为(86.0±4.4)分、(87.7±4.2)分、9.5°±1.1°、11.0°±1.6°、9.0°±1.8°、(9.2±1.3)mm.以上项目两组间比较差异均无统计学意义(P＞0.05),但以上项目同一组内末次随访时均较术前显著改善,差异均有统计学意义(P＜0.05).结论 髌骨侧贴面固定与隧道固定重建MPFL治疗青少年复发性髌骨脱位,均能改善青少年髌股关节对位关系,有助于膝关节功能的改善及髌骨稳定性的提高.
Abstract
Objective To compare the lateral veneer fixation versus the tunnel fixation for recon-struction of the medial patellofemoral ligament(MPFL)in the treatment of recurrent patellar dislocation in adolescents.Methods A retrospective study was conducted to analyze the data of 50 adolescent patients with recurrent patellar dislocation who had been treated at Department of Pediatric Orthopedics,The Sixth Affil-iated Hospital of Xinjiang Medical University from January 2020 to January 2023.There were 12 males and 38 females with an age of(15.0±0.9)years,and 23 cases on the left and 27 cases on the right.The number of preoperative dislocations was(2.5±0.9)times.According to the surgical methods,the patients were divided into 2 groups:a veneer group of 25 cases whose MPFL was reconstructed by the patellar lateral veneer fixation,and a tunnel group of 25 cases whose MPFL was reconstructed by the patellar tunnel fixation.The 2 groups were compared in terms of Kujala score,Lysholm score,lateral patellofemoral angle(LPFA),congruence angle(CA),patellar tilt angle(PTA),and lateral patellar displacement(LPT)at the last follow-up.Results As the differences in the preoperative general data between the groups were insignificant,the 2 groups were com-parable(P＞0.05).The 50 patients were followed up for(24.1±5.1)months after surgery.There were no complications like patellar fracture or limitation of joint flexion-extension in either group after surgery,and neither group experienced any further patellar dislocation at the last follow-up.The Kujala score,Lysholm score,LPFA,CA,PTA and LPT at the last follow-up were(87.8±4.3)points,(88.3±4.7)points,9.5°±1.1°,10.8°±1.4°,9.6°±1.0°,and 9.2±1.3 mm in the veneer group,and(86.0±4.4)points,(87.7±4.2)points,9.5°±1.1°,11.0°±1.6°,9.0°±1.8°,and(9.2±1.3)mm in the tunnel group,re-spectively,showing no statistically significant difference between the 2 groups(P＞0.05).However,there were significant improvements within each group in the comparisons of the above indexes between pre-surgery and the last follow-up(P＜0.05).Conclusion In the treatment of recurrent patellar dislocation in adolescents,both lateral veneer fixation and tunnel fixation to reconstruct the MPFL can improve the align-ment of the patellofemoral joint in adolescents,contributing to the improvement of knee joint function and patellar stability.
基金项目
新疆维吾尔自治区自然科学基金面上项目(2021D01C453)
NETL
NSTL
万方数据