CAJ | 학술논문

目的探讨关节镜辅助下自体部分腓骨长肌腱移植重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗复发性髌骨脱位的疗效.方法 2009年5月-2010年4月治疗46例53膝复发性髌骨脱位患者,关节镜下进行外侧髌股支持带松解后,采用自体部分腓骨长肌腱游离移植重建MPFL,调整移植肌腱在不同角度下屈伸活动时的张力,关节镜下观察髌骨运动轨迹和股骨滑车与髌骨的对应关系,然后采用可吸收界面螺钉将肌腱端固定于股骨内侧髁的骨道内,同时行胫骨结节内移抬高术.了解髌股关节的稳定情况、脱位复发、患膝主观症状以及患肢整体功能康复情况.结果术后随访平均18个月(12～24个月),膝关节稳定性增加,髌骨脱位无复发.恐惧试验阴性,髌骨轴位X线片和CT示髌股关节解剖关系恢复正常.手术前后Kujala 髌骨稳定度问卷评分术前(54.6±5.4)分,术后(92.3±8.9)分(t =55.41,P＜0.01).所有患者运动能力均较术前有所改善.术后CT检查对比发现,髌骨与股骨滑车适配角从术前的(27.8±8.1)°改善为(2.3±9.4)°(t=20.87,P＜0.01).肌腱供区踝关节活动良好,功能没有影响.结论关节镜下外侧髌股支持带松解与自体部分腓骨长肌腱移植重建MPFL,结合胫骨结节内移抬高术能够有效治疗复发性髌骨脱位,并且避免了膝关节周围切取肌腱的潜在并发症.
목적 탐토관절경보조하자체부분비골장기건이식중건내측빈고인대(medial patellofemoral ligament,MPFL)치료복발성빈골탈위적료효.방법 2009년5월-2010년4월치료46례53슬복발성빈골탈위환자,관절경하진행외측빈고지지대송해후,채용자체부분비골장기건유리이식중건MPFL,조정이식기건재불동각도하굴신활동시적장력,관절경하관찰빈골운동궤적화고골활차여빈골적대응관계,연후채용가흡수계면라정장기건단고정우고골내측과적골도내,동시행경골결절내이태고술.료해빈고관절적은정정황、탈위복발、환슬주관증상이급환지정체공능강복정황.결과 술후수방평균18개월(12～24개월),슬관절은정성증가,빈골탈위무복발.공구시험음성,빈골축위X선편화CT시빈고관절해부관계회복정상.수술전후Kujala 빈골은정도문권평분술전(54.6±5.4)분,술후(92.3±8.9)분(t =55.41,P＜0.01).소유환자운동능력균교술전유소개선.술후CT검사대비발현,빈골여고골활차괄배각종술전적(27.8±8.1)°개선위(2.3±9.4)°(t=20.87,P＜0.01).기건공구과관절활동량호,공능몰유영향.결론 관절경하외측빈고지지대송해여자체부분비골장기건이식중건MPFL,결합경골결절내이태고술능구유효치료복발성빈골탈위,병차피면료슬관절주위절취기건적잠재병발증.
Objective To investigate effects of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) using partial peroneus longus tendon autograft in treating recurrent patellar dislocation.Methods Forty-six patients (53 knees) with recurrent dislocation of patella received autologous partial peroneus longus tendon grafting for MPFL reconstruction after arthroscopic lateral retinaculum release from May 2009 to April 2010.Anatomic relation between femoral trochlea and patella,and motion path of patella were observed arthroscopically in adjustment of flexion and extension strength of grafted tendon in different angles.Successively,the tendon ends were fixed within bone tunnel of medial femoral condyle by using absorbable interface screws with synchronous superomedial displacement of tibial tuberosity.Stability of patellofemoral joint,dislocation recurrence,subjective symptoms of affected knees and general function recovery condition of affected limbs were studied.Results All patients were followed up for average 18 months (range,12-24 months),which showed the improvement of knee joint stability,without recurrence of patellar dislocation.Apprehensive test was negative.Axial X-ray films and CT of patella showed normal anatomical relation of patellofemoral joint.The Kujala patellar stability questionnaire scored (54.6 ±5.4) points before operation and (92.3 ±8.9) points after operation (t =55.41,P ＜ 0.01).All patients showed some improvement of motor ability after operation.CT examination showed that the congruence angle of patella and femoral trochlea was improved from preoperative (27.8 ± 8.1) ° to postoperative (2.3 ± 9.4) ° (t =20.87,P ＜ 0.01).Otherwise,ankle joint in the tendon donor site acted well,with normal function.Conclusion Arthroscopic lateral patellar retinaculum release and MPFL reconstruction using partialperoneus longus tendon autograft are effective in treatment of recurrent patellar dislocation in combination with superomedial displacement of tibial tuberosity,and avoid potential complications in tendon removal from around knee joint.