内侧髌股韧带与股内斜肌在急性髌骨外侧脱位后的MRI表现

目的:分析内侧髌股韧带(MPFL)与股内斜肌(VMO)在急性髌骨外侧脱位后的MRI表现,以及MPFL与VMO损伤的相关性.方法:选择106例急性髌骨外侧脱位患者的MRI资料,分析MPFL、VMO损伤的MRI表现特点,统计损伤程度、部位,并分析相关性.结果:106例中,MPFL损伤发生率为77.4％(82/106),其中...     

急性创伤性髌骨外侧脱位后内侧髌股韧带和股骨外侧髁关节软骨损伤的MRI分析

目的探讨急性创伤性髌骨外侧脱位后内侧髌股韧带(MPFL)和股骨外侧髁关节软骨损伤的MRI特点。方法回顾性分析51例经临床证实的急性创伤性髌骨外侧脱位患者的MRI资料。51例病例均行常规MRI矢状面、冠状面和横断面T1WI、T2WI、脂肪抑制FSE双回波序列扫描,并与手术结果相对照。结果急性创伤性髌骨外侧脱位后,MPFL损伤发生率为100%,其中完全性MPFL撕裂31例,部分性MPFL撕裂20例,股骨侧撕裂30例,髌骨侧撕裂19例,体部撕裂2例,MRI诊断MPFL部分性撕裂的敏感性、特异性和准确性分别为85%、93.5%和90.2%,MRI诊断完全MPFL撕裂的敏感性、特异性和准确性分别为93.5%、85%和90.2%。股骨外侧髁关节软骨损伤17例,发生率为33.3%,其中13例位于股骨外侧髁承重面关节软骨,1例位于股骨滑车,3例股骨滑车和股骨外侧髁承重面关节软骨均受累;17例股骨外侧髁关节软骨损伤病例中,16例(94.1%)关节软骨损伤位于股骨外侧髁骨挫伤的偏后部分,1例(5.9%)位于骨挫伤的中间部分;MPFL髌骨侧损伤病例中,57.9%(11/19)伴发股骨外侧髁关节软骨损伤,MPFL股骨侧损伤病例中,20%(6/30)伴发股骨外侧髁关节软骨损伤,二组数据比较,差异具有显著统计学意义(χ2=5.80,P=0.016)。MPFL完全撕裂、部分撕裂病例中,股骨外侧髁骨软骨骨折发生率分别为19.4%(6/31)、0%(0/20),二者比较,差异具有显著统计学意义(χ2=4.39,P=0.036)。结论急性创伤性髌骨外侧脱位后,MPFL股骨侧最易损伤,其次为髌骨侧,MRI诊断MPFL损伤准确性高;急性创伤性髌骨外侧脱位后股骨外侧髁关节软骨损伤比较常见,MPFL髌骨侧损伤病例易于伴发股骨外侧髁关节软骨损伤,而MPFL完全撕裂较部分撕裂更易伴发股骨外侧髁骨软骨骨折;股骨外侧髁关节软骨损伤多位于股骨外侧髁承重关节面处,绝大多数位于股骨外侧髁骨挫伤的偏后部分。     

分析比较急性髌骨外侧脱位与膝关节多发韧带损伤后内侧髌股韧带损伤的特点

 目的 分析比较急性髌骨外侧脱位(lateral patellar dislocation,LPD)与膝关节多发韧带损伤(multiligament knee injuries,MLKIs)后内侧髌股韧带(medial patellofemoral ligament,MPFL)损伤的特点。方法 回顾性分析急性LPD 92例和MLKIs 83例患者的MRI资料,根据患者年龄分为青少年组(年龄≤18岁)84例和成人组(年龄＞18岁)91例,对LPD和MLKIs伴发MPFL损伤程度、部位进行统计学分析。结果 青少年LPD组50例中,MPFL部分撕裂20例,完全撕裂25例,未损伤5例;青少年MLKIs组34例患者中,MPFL部分撕裂9例,完全撕裂6例,未损伤19例;两组比较,差异有统计学意义(χ²=21.725,P<0.05)。青少年LPD组MPFL髌骨侧损伤19例,股骨侧14例,体部2例,多部位损伤10例;青少年MLKIs组MPFL髌骨侧损伤3例,股骨侧7例,多部位损伤5例;青少年LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ²=19.753,9.644,8.193,P值均小于0.01)。成人LPD组42例中,MPFL部分撕裂17例,完全撕裂19例,未损伤6例;成人MLKIs组49例中,MPFL部分撕裂13例,完全撕裂7例,未损伤29例;两组比较,差异有统计学意义(χ²=20.771,P<0.05)。成人LPD组MPFL髌骨侧损伤11例,股骨侧15例,体部2例,多部位损伤8例;成人MLKIs组MPFL髌骨侧损伤4例,股骨侧9例,多部位损伤7例;LPD组和MLKIs组间MPFL髌骨侧、股骨侧、多部位损伤发生率差异均具有统计学意义(χ²=14.773,12.777,6.822,P均<0.01)。结论 急性LPD比MLKIs更易导致MPFL损伤,MPFL髌骨侧损伤、股骨侧损伤和多部位损伤LPD也较MLKIs更常见。     

软组织固定重建内侧髌股韧带治疗青少年复发性髌骨脱位

目的:分析应用软组织固定技术重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗青少年复发性髌骨脱位的临床疗效。方法:2014年3月至2016年10月期间对12例诊断为复发性髌骨脱位的青少年患者,取自体半腱肌腱行MPFL重建术。全部运用软组织固定技术完成重建。术后实施快速康复方案。术前及术后随访期间根据Lysholm、IKDC和Kujala膝关节功能评分评估临床效果。调查患者术后满意度及恢复体育活动情况。结果:所有患者均获得随访,时间为6~18个月(平均12个月)。全部12例患者均无再发脱位,最终随访时均恢复全范围活动度和正常的内侧结构稳定。术后Lysholm、IK-DC和Kujala膝关节功能评分均较术前有显著提高(P<0.01)。10例患者对手术效果非常满意,其余2例为满意。75%(9/12)的患者术后6月后可以恢复术前的体育运动水平(均非专业运动员)。结论:应用软组织固定技术重建MPFL获得了显著的临床疗效。该方法避免了骨隧道及内植入物的相关并发症。对于骨骺未闭的青少年患者,是一种安全、有效、牢靠的手术技术。     

髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位

目的:探讨采用髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位的手术方法和临床效果。方法:2006年9月至2009年2月,对12例习惯性髌骨脱位患者的13个膝关节进行了手术治疗,男4例,女8例,平均年龄27岁。全部病例行髌骨外侧软组织松解,内侧关节囊紧缩,取带Gerdy’s结节骨块的髂胫束组织重建内侧髌股韧带。结果:全部患者均得到随访,随访时间1～3年,平均23个月。1例双膝手术者脱位复发,余11例无髌骨再脱位。2例患者膝关节屈曲略受限。5例感膝关节无力。结论:髌骨外侧软组织松解,内侧关节囊紧缩,髂胫束重建内侧髌股韧带治疗习惯性髌骨脱位,操作简单,效果可靠,手术损伤小,恢复快。     

关节镜辅助下LARS人工韧带重建内侧髌股韧带治疗复发性髌骨脱位

目的探讨关节镜辅助下韧带先进加强系统(ligament advanced reinforcement system,LARS)人工韧带重建内侧髌股韧带(medial patellofemoral ligament,MPFL)治疗复发性髌骨脱位(recurrent dislocation ofpatella,RDP)的临床疗效。方法我院自2007年3月～2008年7月收治了6例RDP(1例为双膝)的患者,术前行X片、CT、MRI了解髌股关节及MPFL情况,术中先用关节镜观察髌股关节的对合关系、运动轨迹及关节软骨情况;用LARS人工韧带重建MPFL;重建后关节镜检查髌股关节对合关系和运动轨迹恢复情况。术后逐步进行膝关节功能锻炼,并用Insall评定标准进行术后评分。结果随访6～24个月,平均13个月,无伤口感染、移植物排斥反应和断裂。按Insall评定标准,优5例,良1例。X片示髌骨复位良好,髌骨无复发性脱位或半脱位。结论关节镜辅助下LARS人工韧带重建MPFL能有效治疗RDP。     

急性髌骨脱位中内侧支持带复合体的损伤：MR表现及其外科意义

本文通过对膝关节内侧支持带复合体正常解剖的复习，讨论了在急性髌骨脱位中内侧支持带复合体损伤的ＭＲ表现，强调对有急性髌骨脱位病人ＭＲ观察侧重点，并明确了其外科意义。     

内侧髌股韧带急性损伤的磁共振诊断研究

目的 探讨内侧髌股韧带（MPFL）急性损伤的MRI表现。方法 回顾分析经MRI成像及临床证实的36例急性MPFL损伤患者的MRI资料,观察MPFL及膝关节其它结构损伤的MRI表现。结果 36例MPFL损伤中,17例发生股骨侧,11例发生在髌骨侧,8例发生在韧带体部。36例MPFL损伤中,挫伤为19例,部分撕裂11例,完全撕裂6例。36例MPFL损伤中,11例存在髌骨半脱位,3例存在髌骨脱位,25例存在骨挫伤,8例存在骨软骨骨折,16例存在内侧副韧带损伤,17例存在股内侧斜肌损伤,15例存在半月板损伤,36例均有不同程度关节积液。结论 MRI诊断MPFL损伤以横断位最佳。MRI可以对MPFL损伤进行准确诊断和分级,典型的其它结构伴发损伤对诊断急性MPFL损伤有重要提示作用。     

Recurrent patellar dislocation after medial patellofemoral ligament reconstruction

We report on three cases of recurrent lateral patellar dislocation following a medial patellofemoral ligament (MPFL) reconstruction for patellar instability. In all three cases, an isolated MPFL reconstruction was performed with a double autogenous gracilis graft. The patellar fixation was done through bone tunnels. All three patients presented with a definite moderate to severe traumatic episode resulting in a recurrent patella dislocation and a transverse avulsion fracture at the medial rim of the patella. All three were treated by an open reduction and internal fixation with good results. No complication or recurrent dislocations occurred. We suggest that this complication is caused by the original underlying pathology such as dysplastic trochlea, abnormal TT–TG, patella alta and hyperlaxity, resulting a greater reliance upon the reconstructed MPFL for patellar stability. When subjected to a severe stress, the graft, which is stronger and stiffer than the original MPFL, will cause a fracture through the medial edge of the patella. This weak area results from the previous drill holes, which act as stress risers.     

高频超声与磁共振对急性外伤性髌骨外侧脱位的对比研究

目的比较分析高频超声与磁共振(MRI)对急性外伤性髌骨外侧脱位的诊断价值。方法对33例临床证实急性外伤性髌骨外侧脱位的高频超声和MRI资料,以手术结果为金标准,计算高频超声、MRI诊断各种伴随伤的敏感性、特异性和准确性,比较两种检查方法的有效性。结果与手术结果比较,高频超声、MRI诊断MPFL部分撕裂的敏感性、特异性、准确性分别为85.7%、85.7%,94.7%、89.5%,90.9%、87.9%;诊断MPFL完全撕裂的敏感性、特异性、准确性分别为94.7%、89.5%,85.7%、85.7%,90.9%、87.9%。高频超声、MRI诊断关节软骨Ⅱ级损伤的敏感性、特异性、准确性分别为36.4%、81.8%,85%、100%,67.7%、93.5%。高频超声、MRI诊断关节软骨Ⅲ级损伤的敏感性、特异性、准确性分别为81.8%、90.9%,85%、90%,83.9%、90.3%;高频超声、MRI诊断关节软骨Ⅳ级损伤的敏感性、特异性、准确性分别为100%、100%,90.9%、95.5%,93.5%、96.8%。高频超声对MPFL撕裂、关节软骨损伤的诊断与MRI比较差异无统计学意义(P>0.05)。结论高频超声检查与MRI检查同样能对急性外伤性髌骨外侧脱位的各种伴随损伤明确诊断和准确分级,是一种简单可靠、快捷并可重复的诊断方法,可作为急性外伤性髌骨外侧脱位的常规检查方法。     

Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

Purpose

The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint.

Materials and methods

Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation.

Results

After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults.

Conclusion

First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus, physicians are confronted with similar anatomical risk factors and similar injuries to the medial soft-tissue restraints in children when compared to adults with patellar instability.     

A long-term follow-up study after medial patellofemoral ligament reconstruction using the transferred semitendinosus tendon for patellar dislocation

The management of patellar dislocation syndrome has traditionally been difficult. There are no golden standard methods for patellar dislocations probably due to the many etiologies. However, it is known that medial patellofemoral ligament (MPFL) is damaged when the patella is dislocated. The purpose of this study is to examine whether our method of MPFL reconstruction is useful for the treatment of dislocated patellae and unstable patellae. Forty-six knees (43 patients) of 68 knees (65 patients) that were operated on using our surgical procedure for MPFL reconstruction with the advancement of the vastus medialis or the MPFL reconstruction with Insalls procedure were followed up for at least 5 years. The patient age ranged from 6 to 43 years. These knees consisted of six habitual dislocation patellae, twenty-six recurrent dislocation patellae, ten traumatic dislocation patellae, and four unstable patellae. The patients were evaluated pre-operatively and more than three times post-operatively at 6, 12, 36, 60, or 120 months. No patient experienced patellar dislocation after surgery. Their post-operative Kujalas scores were significantly improved. On conventional X-ray and on stress X-ray evaluations, the mean values for congruence angle, tilting angle, lateral shift ratio, medial stress shift ratio, and lateral stress shift ratio at the final follow-up (60 or 120 months) were demonstrated to be within the normal range. We conclude that our MPFL reconstruction method with the advancement of the vastus medialis or with Insalls procedure might be recommended for the treatment of habitual, recurrent, and indeed any other type of patellar dislocation, as well as for unstable patellae.     

3．0TMRI 在肘关节脱位后内侧副韧带前束损伤中的应用

目的：探讨3．0TMRI在肘关节脱位后内侧副韧带前束损伤中的应用。方法回顾性分析20例肘关节脱位患者内侧副韧带前束损伤的M RI征象;常规行冠状位、矢状位、轴位及薄层斜冠状位扫描,扫描序列包括SET1WI、T2加权预饱和脂肪抑制序列（T2 WI‐FS）。结果20例患者中,内侧副韧带前束均有不同程度损伤,其中轻度损伤8例,部分撕裂5例,完全断裂7例;另外11例伴外侧副韧带损伤,5例伴环状韧带损伤,9例伴屈／伸肌总腱损伤,7例伴发骨折。结论3．0TMRI能准确诊断肘关节脱位后内侧副韧带前束损伤,并能明确其损伤程度;对肘关节脱位患者宜常规行M RI检查。     

Augmented repair of avulsion-tear type medial patellofemoral ligament injury in acute patellar dislocation

This study investigated the results of augmented repair for avulsion-tear type medial patellofemoral ligament (MPFL) injury performed on a total of five knees with initial acute lateral patellar dislocation. Augmented repair was performed using a medial retinaculum slip on all five knees. The average follow-up was 5.9 years. The results were evaluated with the Insall, Aglietti, and Tria grading system. Three knees were classified as excellent, one knee as good, and one knee as fair. The mean Kujala score at follow-up was 97.6 points. Augmented repair of the injured MPFL for avulsion-type MPFL injury may be considered as one good option to prevent subsequent dislocation and subluxation.     

部分腓骨长肌腱重建内侧髌股韧带治疗复发性髌骨脱位

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.