半腱肌肌腱移植双束解剖重建治疗复发性髌骨脱位

 目的 探讨关节镜下半腱肌肌腱移植双束解剖重建内侧髌股韧带治疗复发性髌骨脱位的疗效。方法 自2006年1月至2010年1月收治复发性髌骨脱 位29例（31膝），男11例，女18例（20膝）；年龄16～32岁，平均22岁。游离自体半腱肌肌腱，双束重建内侧髌股韧带，以双锚钉及骨槽固定于髌骨，股骨止点 采用界面螺钉固定，于关节镜下调整髌骨复位。5例同时行胫骨结节前内移术。所有病例均获得随访，随访时间9～22个月，平均14个月。影像学评价包括测量髌 股适合角、外侧髌股角、髌骨外移率；临床疗效评价包括国际膝关节评分委员会（International Knee Documentation Committee，IKDC）膝关节功能主观评分 、Lysholm膝关节功能评分及Tegner膝关节运动评分。结果 术后恐惧试验均阴性，随访期间无髌骨再脱位及骨折发生。末次随访时髌股适合角5.65°±2.23°、 外侧髌股角3.52°±2.63°、髌骨外移率0.25±0.46，与术前比较差异有统计学意义（P<0.05）；IKDC膝关节功能主观评分（93.20±5.33）分、Lysholm膝关 节功能评分（93.02±6.08）分及Tegner膝关节运动评分（6.58±0.87）分，与术前比较差异有统计学意义（P<0.05）。结论 关节镜下半腱肌肌腱移植双束解 剖重建内侧髌股韧带治疗复发性髌骨脱位的近期效果可靠。

Anatomically reconstruction of medial patellofemoral ligament with grafted dual-bundle semitendinosus for recurrent dislocation of the patella

Objective To investigate the effect of recurrent patella dislocation by grafting dual-bundle semitendinosus to anatomically reconstruct of medial patellofemoral ligament (MPFL) under arthroscopy. Methods From January 2006 to January 2010, 29 cases (31 knees) with recurrent dislocation of the patella were performed arthroscopic surgery, including 11 males and 18 females (20 knees) with an average age of 22 years (range, 16-32). The key point of surgery was reconstruction MPFL with dual-bundle free autogenous semitendinosus by using two anchors and bone groove to fixed on the patella, and using the interference screw to fixed on the femur. Adjusting the patella reset under arthroscopy. Tibial tubercle were transferred to inside in 5 cases. All patients were followed up for an average of 14 months (ranging 9- 22). The imaging evaluation included congruence angle, lateral patellofemoral angle and lateral shift. The clinical therapeutic effect was evaluated with International Knee Documentation Committee (IKDC), Lysholm and Tegner scores. Results The fear test was negative after operation. There was no redislocation and fracture of the patella during follow-up. The congruence angle, lateral patellofemoral angle and lateral shift were 5.65°±2.23°, 3.52°±2.63° and 0.25?0.46 respectively at the final follow-up. The mean IKDC, Lysholm and Tegner scores were 93.20?5.33, 93.02?6.08 and 6.58?0.87 respectively at the final follow-up. All were showed statistically significant differences compared with preoperation (P<0.05). Conclusion It is demonstrated that there was a reliable short-term effect to treat recurrent patella dislocation by grafting dual-bundle semitendinosus to anatomically reconstruct of MPFL under arthroscopy.