内侧髌股韧带重建治疗复发性髌骨脱位疗效观察

目的 探讨内侧髌股韧带重建治疗复发性髌骨脱位的临床效果.方法 回顾性分析湖北省荆州市中心医院2017年1月至2019年6月通过关节镜辅助下内侧髌股韧带双束重建治疗的29例复发性髌骨脱位患者的临床资料.其中,男10例,女19例,年龄14.0～29.5岁,平均19.4岁.测量TT-TG距离、髌骨倾斜角,计算Caton指数....     

同种异体韧带重建内侧髌股韧带术治疗复发性髌骨脱位

目的探讨同种异体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 of knee-cap,RDP)的疗效。方法采用同种异体韧带重建内侧髌股韧带治疗复发性髌骨脱位21例,男9例,女12例;平均年龄33.9岁,根据Lysholm膝关节功能评定表评估膝关节功能来评价疗效。结果术后随访6~24个月,平均随访9.7月,优良19例,可差2例,优良率90.4%。结论同种异体韧带重建内侧髌骨韧带治疗复发性髌骨脱位安全,可靠。     

髌外侧支持带松解内侧髌股韧带紧缩术治疗习惯性髌骨脱位

目的:探讨外侧支持带松解内侧髌股韧带重建术治疗习惯性髌骨脱位及半脱位的手术方法及临床疗效.方法:经对10例(13膝)经临床检查确诊的髌骨脱位及半脱位患者,在行髌外侧支持带松解内侧髌股韧带紧缩的的基础上,配合胫骨结节内移等手术治疗.手术前后均对患者的膝关节功能进行Lysholm评分.结果:10例患者随访3～15个月(平均9个月),术后膝关节稳定性增加,无髌骨再脱位发生,恐惧试验均为阴性.Lysholm评分术前平均(69.6±3.9),术后平均(94.1±3.7).结论:髌外侧支持带松解内侧髌股韧带紧缩为主的综合术式治疗髌骨脱位能有效减轻症状防止复发,,对维持髌骨的稳定有重要作用.     

内侧髌骨韧带重建治疗青少年复发性髌骨脱位

<正>复发性髌骨脱位是青少年常见的膝关节疾病,大多是在膝关节局部结构发育不良或肌肉力量不平衡的基础上经过轻微外伤而引起的。由于这种疾病可造成长期的诸如膝关节疼痛、不稳定、绞锁、脱位感和肿胀等症状,严重影响青少年的日常活动,往往保守治疗效果不佳,多数需要手术治疗。近年来采用节镜辅助下自体半腱肌重建内侧髌股韧带治疗青少年复发性髌骨脱位取得了较好的疗效,现报道如下。1资料和方法1.1一般资料     

关节镜下膝内侧支持带紧缩外侧支持带松解治疗髌骨脱位

目的 　探讨关节镜下膝内侧支持带紧缩外侧支持带松解术在治疗髌骨脱位中的临床疗效。 方法 自2009 年3 月～2011年7月收治25 例25膝髌骨脱位,术前未接受过外科手术治疗。术中关节镜监视下松解外侧支持带并紧缩缝合内侧支持带。术后行正规康复训练。随访18～24个月,了解膝关节脱位复发情况及患膝功能恢复情况。 结果　术后无髌骨脱位复发,手术前后Lysholm 膝关节功能综合评分分别为（59.00±13.37）分和 （92.14±5.15）分（P＜0.05）;手术后影像测量对比髌骨适合角从术前（21.10±5.61）°纠正到（-1.70±7.41）°(P＜0.05);外侧髌股角从术前（-1.3±1.6）°纠正到（6.1±1.4）°(P＜0.05）,上述3项指标手术前后比较,均有统计学差异。 结论　关节镜辅助下膝内侧支持带紧缩配合外侧支持带松解术治疗髌骨脱位,手术创伤小,疗效满意。     

关节镜下有限切开内侧髌股韧带重建对复发性髌骨脱位患者的治疗疗效及应激因子的影响分析

目的探讨关节镜下有限切开内侧髌股韧带(Medial patellofemoral ligament,MPFL)重建对复发性髌骨脱位患者的治疗疗效,并分析该方案对患者应激因子的影响。方法选取我院2009年9月~2013年9月收治的71例复发性髌骨脱位患者,实施关节镜下有限切开MPFL重建治疗。对其进行为期1年的随访,观察其围术期应激因子变化及随访期间膝关节髌骨稳定性、膝关节评分变化。结果患者术前髌骨外推检验、恐惧试验、J-sign试验优良率均为0。术后6个月患者髌骨稳定性试验优良率均达100%,与治疗前比较差异有统计学意义(0.01)。患者术后6周Lysholm评分、HSS评分即显著上升(0.05)。患者术后6小时、术后1天血清应激反应因子ACTH、Cor、IL-6、IL-10、MDA均显著上升,NO显著下降(0.05)。术后3天患者血清应激反应因子水平与术前1天比较未见明显统计学差异(0.05)。患者术后7天SAS、SDS量表评分均较术前1天显著降低,差异有统计学意义(0.05)。结论关节镜下有限切开MPFL能够有效改善复发性髌骨脱位患者髌骨及膝关节稳定性,并能够在一定程度上控制应激反应因子水平稳定、缓解心理应激状态,对患者术后恢复及预后的改善均具有积极意义。     

关节镜下外侧支持带松解内侧髌股韧带重建治疗复发性髌股关节脱位

目的　探讨关节镜辅助下外侧支持带松解联合内侧髌股韧带（medial patellofemoral ligament,MPFL）重建手术治疗复发性髌骨脱位的临床效果。 方法　对我院2012年1月-2015年1月收治的19例复发性髌骨脱位患者,采取关节镜辅助下行外侧支持带松解、内侧髌股韧带重建联合手术。术后定期随访,记录术前和术后影像学结果、Lysholm 膝关节功能综合评分和 Kujala 髌股关节评分,观察重建韧带长度变化。 结果　19例均获随访,时间( 25.7±8. 56) 月（12~48月）,术后无髌骨再脱位及恐惧征,无髌股关节疼痛加重,X线显示Q角在正常范围,膝关节CT（屈膝45°）显示患者髌骨外侧关节面张开角从术前平均（-1.2±6.8)°（-16°~8°）提高至术后(11.2±5.1)°（5°~18°）,较术前有显著性差异（P＜0.01）。术后1年Lysholm 评分及Kujala 髌股关节评分较术前有明显改善。重建韧带长度术后即刻平均为（57.81±6.76）mm,术后1年为（58.36±6.87）mm,无明显松弛。 结论　关节镜辅助下二联手术治疗复发性髌骨脱位,能有效恢复髌股关节位置和功能,预防复发,术后1年韧带无明显松弛,疗效满意。     

自体肌腱移植双束解剖重建内侧髌股韧带治疗髌骨脱位

背景：对于髌骨不稳的治疗,临床上一般分为保守和手术治疗,其中手术治疗方法众多,每种方法各有侧重,对于使用何种方法治疗髌骨不稳,目前仍没有形成统一的共识。 目的：探讨应用自体移植肌腱双束解剖重建内侧髌股韧带治疗髌骨脱位。 方法：选择安徽医科大学第一附属医院骨科行膝关节镜辅助下内侧髌股韧带重建髌骨脱位患者46例,所有患者均采用自体移植肌腱双束解剖重建。 结果与结论：重建后随访2~16个月,观察患者关节稳定性及灵活度。46例患者随访期间未见严重并发症,患膝轻度伸直受限1例,重建后均未见髌骨复发脱位。重建后随访Lysholm膝关节评分和Kujala评分均高于重建前(P < 0.01)。结果证实,采用膝关节镜辅助下自体移植肌腱双束解剖重建内侧髌股韧带治疗髌骨脱位效果较好。      

关节镜下内侧支持带重叠缝合联合外侧松解治疗青少年创伤性髌骨脱位的临床研究

目的 探讨膝关节镜下内侧支持带重叠缝合联合外侧支持带松解治疗伴有撕脱性骨折的创伤性髌骨脱位的临床疗效。方法 回顾性分析2018年5月至2021年5月秦皇岛市第一医院诊治的30例青少年初次创伤性髌骨脱位合并髌骨内侧缘撕脱性骨折的患者,均在关节镜下采用内侧支持带重叠缝合联合外侧支持带松解方法治疗。评估膝关节优良率,术后6个月及1年的Kujala髌股关节评分、Lysholm膝关节评分、IKDC膝关节评分的改善情况,记录术前、术后6个月、术后1年的膝关节活动度、髌骨倾斜角、髌骨适合角及髌骨外移率。结果 ①30例患者术后均恢复良好,髌骨位置解剖复位,术后平均随访时间为12.1个月（10 ～ 18个月）,均无复发性脱位或半脱位发生;②膝关节优良率、Kujala髌股关节评分、Lysholm评分、IKDC评分分别由术前的3.3%、（45.3±2.2）分、（36.8±2.5）分、（53.5±4.9）分提高至术后1年的93.3%、（92.9±2.2）分、（94.8±3.5）分、（98.3±5.0）分,差异均具有统计学意义（P＜0.05）;③膝关节活动度由术前的（25.3±4.5）°提高至术后1年的（125.4±3.2）°,髌骨倾斜角、髌骨适合角及髌骨外移率分别由术前的（12.5±1.8）°、（19.2±1.9）°、（18.5±2.3）%降至术后1年的（5.6±0.7）°、（6.8±1.0）°、（6.9±0.8）%,差异均具有统计学意义（P＜0.05）。结论 膝关节镜下内侧支持带重叠缝合联合外侧支持带松解治疗伴有撕脱性骨折的创伤性髌骨脱位安全有效,可获得稳定的髌骨运动轨迹,术后中短期随访影像学指标和临床功能评分满意。     

关节镜下“三联术”治疗复发性髌骨脱位

目的 探讨关节镜辅助下“三联术”治疗复发性髌骨脱位的疗效.方法 2008年4月～2011年9月,应用关节镜辅助下髌股外侧支持带松解、内侧支持带重建、胫骨结节截骨内移抬高术治疗复发性髌骨脱位16例.男4例,女12例;年龄19～43岁,平均22.8岁.初次脱位机制均为外伤,术前平均脱位次数均超过4次.其中左侧7膝,右侧9膝.患者均为向外侧脱位,且脱位后均可手法复位.体格检查恐惧试验阳性,倾斜试验阳性,被动活动受限,膝关节内侧压痛明显.结果 术后切口均Ⅰ期愈合.对16例患者均获得满意随访,随访时间1～2年,平均随访16.7个月.术后3个月内,有3例患者出现髌骨外侧疼痛,5膝出现髌骨内侧紧绷牵拉感,经理疗锻炼后均逐渐消失或好转.随访期间均无髌骨脱位再发生.膝关节术后1年时的Lysholm评分为(95.7±4.2)分,明显高于术前的(63.7±5.3)分,结果有明显的差异性,具有统计学意义(P＜0.05);术后1年Kujala评分为(90.3±2.6)分,也明显高于术前的(61.3±4.3)分,差异有统计学意义(P＜0.05).术后1年患膝功能恢复评分采用Insall标准,其中优13膝,良2膝,可1膝,优良率达93.7％.结论 关节镜辅助下“三联术”治疗复发性髌骨脱位的关节创伤小,恢复佳,早期临床效果满意,值得在临床工作中广泛应用.     

Lateral retinacular release in concordance with medial patellofemoral ligament reconstruction in patients with recurrent patellar instability: A computational model

BackgroundThe aim of this study was to develop and validate a finite element (FE) model of the patellofemoral joint to analyze the biomechanics of lateral retinacular release after medial patellofemoral ligament (MPFL) reconstruction in patellar malalignment (increased tibial tubercle–trochlear groove distance (TT-TG)). We hypothesized that lateral retinacular release is not appropriate in patellar instability addressed by MPFL reconstruction due to decreased lateral stability and inappropriate adjustment in patellofemoral contact pressures.MethodsA FE in-silico model of the patellofemoral joint was developed and validated. The model was used analyze the effect of lateral retinacular release in association with MPFL reconstruction on patellofemoral contact pressures, contact area, and lateral patellar displacement during knee flexion.ResultsMPFL reconstruction alone results in restoration of patellofemoral contact pressures throughout the entire range of motion (0–90°), mimicking the results from healthy condition. The addition of the lateral retinacular release to the MPFL reconstruction resulted in significant reductions in both patellofemoral contact pressure and contact area. Lateral retinacular release resulted in more lateral patellar displacement during the mid-flexion knee range of motion.ConclusionsCombination of lateral retinacular release with MPFL reconstruction in patients with increased TT-TG is not recommended as MPFL reconstruction alone for first-line management of recurrent patellar instability offers a greater biomechanical advantage and restoration of contact forces to resemble that of the healthy knee. The presented biomechanical data outlines the effect of concomitant MPFL reconstruction and lateral retinacular release to help guide surgical planning for patients with recurrent patellar instability due to malalignment.     

Lateral patellar retinaculum reconstruction for medial patellar instability following lateral retinacular release: A case report

Lateral retinacular release is still being performed in patients with recurrent patellar dislocation as an additional procedure with distal realignment or medial patellofemoral ligament (MPFL) reconstruction. However, consensus remains lacking regarding suitable indications for lateral retinacular release. A 20-year-old woman presented with patellar instability in both medial and lateral directions after undergoing lateral retinacular release with MPFL reconstruction. She displayed inherent systemic joint laxity meeting all seven Carter–Wilkinson criteria. Simultaneous MPFL revision and lateral retinaculum reconstruction successfully improved patellar instability in both directions. This case provides an example of iatrogenic medial patellar instability after failed lateral retinacular release.     

A mid-term follow-up of medial patellofemoral ligament reconstruction using an artificial ligament for recurrent patellar dislocation

A prospective study on medial patellofemoral ligament reconstruction for recurrent patellar dislocation was performed. At an average follow-up of 5.9 years, 27 MPFL reconstructions using a mesh-type artificial ligament and medial retinaculum slip coverage were reviewed using the Crosby and Insall grading system. Fifteen knees (55%) were classified as excellent, 11 knees (41%) as good, 1 knee (4%) as fair/poor and none as worse. At a mid-term follow-up, medial patellofemoral ligament reconstruction should be considered as a safe and effective operation.     

Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft

The purpose of this study was to describe a safer and more anatomical technique of MPFL reconstruction and to report the short-term results. The subjects included 20 patients with patellar dislocation with a mean age of 23. The operation was performed using a double-looped autogenous semitendinosus tendon graft. Two small bone tunnels were made at the medial edge of the patella, mimicking the wide patellar insertion of the MPFL and a bone tunnel was made at the femoral insertion site. The free ends of the graft attached to the patella and the loop end was fixed to the femoral side. Five patients were available for follow-up interviews by telephone and the remaining 15 were directly examined by physical examination and radiographic evaluation at 2 years or longer postoperatively. The average follow-up period was 30 months. Re-dislocation or patellar fracture was not seen in any patients. The average Kujala's score was 96 with a range from 84 to 100. Six patients were classified as excellent and 14 as good, according to the Crosby and Insall grading system. Radiographically, narrowing of the patellofemoral joint space was observed in 2 cases with previous osteochondral fracture out of those who were directly examined. The dual tunnel MPFL reconstruction produces favorable results in subjective and functional assessment of outcome without complications.     

关节镜下盂唇修补与关节囊复合部分肩胛下肌紧缩修复复发性肩关节前脱位

背景：复发性肩关节前脱位的修复目前以关节镜下盂唇修补为主,但是单纯的盂唇修补往往不能满足肩关节稳定性的需要,如何通过修复进一步加强肩关节前方稳定性是一直在探索和追求的问题。目的：探讨采用关节镜下盂唇修补与关节囊复合部分肩胛下肌紧缩缝合修复肩关节复发性前脱位的有效性。方法：选择自2010年10月至2013年8月因复发性肩关节脱位在安徽医科大学第一附属医院骨科运动创伤与关节镜微创治疗中心进行治疗的70例患者,采用关节镜下盂唇修补、关节囊复合部分肩胛下肌紧缩缝合修复方案。治疗后系统康复,定期随访Constant-Murley肩关节评分及ROWE肩关节评分,评估肩关节稳定性及运动功能。结果与结论：70例患者经过11-46个月的随访,1例患者在修复术后出现急性肺水肿,5例患者出现肘部或前臂皮肤水泡,经积极治疗后迅速康复,其他患者均未出现严重并发症。所有患者治疗后肩关节均未再发生脱位。65例患者肩关节活动度恢复基本正常,5例患者肩关节活动度轻度受限,但能够满足日常生活及工作的活动需要。所有患者均能返回原工作岗位正常工作。末次随访Constant-Murley肩关节评分由治疗前的(71.2±5.3)分上升到(94.3±4.9)分,ROWE肩关节评分由治疗前的(32.1±4.2)分上升到(95.1±4.7)分,较治疗前明显增高(P < 0.05)。提示肩关节镜下盂唇修补、关节囊复合部分肩胛下肌紧缩缝合修复复发性肩关节前脱位能够获得良好效果,相比传统开放手术,更有利于患者肩关节稳定和运动功能的恢复。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：