CAJ | 학술논문

背景：内侧髌股韧带（MPFL）是限制髌骨向外侧脱位的主要静力稳定结构，MPFL重建术成为治疗髌骨不稳的主要选择。术中止血带的应用对减少出血量，改善手术视野提供了重要保障，同时也不可避免改变了股四头肌的张力，然而对于髌骨轨迹是否产生明显影响一直未有明确定论。目的：比较MPFL重建术中应用止血带对髌骨轨迹的影响。方法：2008年3月至2011年2月行双束解剖重建MPFL的髌骨复发性脱位患者53例（66膝），男23例（28膝），女30例（38膝）；年龄18~34岁，平均26岁。发病至手术时间1个月~13年，其中44例有明显外伤致髌骨脱位史。术中观察止血带充气前、后对髌骨轨迹的影响，以及是否需行外侧支持带松解。结果：53例（66膝）中，止血带未充气时，判断需行外侧支持带松解者5膝（5/66）；止血带充气后，判断需行外侧支持带松解者6膝（6/66），两者比较无统计学差异（P＞0.05）。重建MPFL后再次应用止血带观察，当止血带充气时，66膝髌骨轨迹良好；当止血带放松后，2膝出现髌骨内移（2/66），两者比较无统计学差异（P＞0.05）。结论：使用止血带前、后对髌骨轨迹无明显影响，术中观察髌骨轨迹良好则无需行外侧支持带松解。
배경：내측빈고인대（MPFL）시한제빈골향외측탈위적주요정력은정결구，MPFL중건술성위치료빈골불은적주요선택。술중지혈대적응용대감소출혈량，개선수술시야제공료중요보장，동시야불가피면개변료고사두기적장력，연이대우빈골궤적시부산생명현영향일직미유명학정론。목적：비교MPFL중건술중응용지혈대대빈골궤적적영향。방법：2008년3월지2011년2월행쌍속해부중건MPFL적빈골복발성탈위환자53례（66슬），남23례（28슬），녀30례（38슬）；년령18~34세，평균26세。발병지수술시간1개월~13년，기중44례유명현외상치빈골탈위사。술중관찰지혈대충기전、후대빈골궤적적영향，이급시부수행외측지지대송해。결과：53례（66슬）중，지혈대미충기시，판단수행외측지지대송해자5슬（5/66）；지혈대충기후，판단수행외측지지대송해자6슬（6/66），량자비교무통계학차이（P＞0.05）。중건MPFL후재차응용지혈대관찰，당지혈대충기시，66슬빈골궤적량호；당지혈대방송후，2슬출현빈골내이（2/66），량자비교무통계학차이（P＞0.05）。결론：사용지혈대전、후대빈골궤적무명현영향，술중관찰빈골궤적량호칙무수행외측지지대송해。
Background:The medial patellofemoral ligament (MPFL) is a very important structure to avoid lateral dislocation of patel-la. The reconstruction of MPFL had been the first choice of treatment for unstable patella. Intraoperative tourniquet has been widely applied, which can improve surgical field and reduce bleeding, but also will inevitably change the tension of quadri-ceps. It has been no definite conclusion whether tourniquet has obvious effect on patellar tracking. Objective:To observe the patella tracking before and after tourniquet inflation. Methods:A total of 53 patients (66 knees) underwent double-stranded anatomic reconstruction of MPFL between March 2008 and February 2011. There were 23 males (28 knees) and 30 females (38 knees) with a mean age of 26 years (range, 18-34 years). The duration from onset of disease to surgical treatment was one month to 13 years. Forty four patients had the history of patellar dislocation caused by trauma. Patella tracking was observed before tourniquet was inflated and after it was released. The lateral retinacular release was recorded. Results:The lateral retinaculum needed to be released in 5 knees before tourniquet inflation and in 6 knees after tourniquet inflation (P>0.05). Under the circumstances of tourniquet inflation, 66 knees had normal patellar tracking after reconstruc-tion of MPFL;under the circumstances of tourniquet release, patellar medial transfer happened in 2 knees (P>0.05). Conclusions:The application of tourniquet has no significant effect on the patella tracking. It is unnecessary to release the lateral retinaculum when patellar tracking is normal during MPFL reconstruction.