| 同种异体肌腱重建内侧髌股韧带治疗习惯性髌骨脱位 |
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Received:June 03, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 唐辉 |
TANG Hui |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
tanghui9791@sina.com |
| 徐永清 |
XU Yong-qing |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 郑天娥 |
ZHENG Tian-e |
成都军区昆明总医院耳鼻喉科, 云南昆明 650032 |
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| 沙勇 |
SHA Yong |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 徐小山 |
XU Xiao-shan |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 赵万秋 |
ZHAO Wan-qiu |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 崔勇 |
CUI Yong |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 张曦娇 |
ZHANG Xi-jiao |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 浦绍全 |
PU Shao-quan |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 李川 |
LI Chuan |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 李春晓 |
LI Chun-xiao |
成都军区昆明总医院全军创伤骨科研究所, 云南昆明 650032 |
PLA Institute of Orthopaedics, Kunming General Hospital of Chengdu Military Command, Kunming 650032, Yunnan, China |
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| 期刊信息：《中国骨伤》2015年28卷，第3期，第252-255页 |
| DOI：10.3969/j.issn.1003-0034.2015.03.013 |
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目的:探讨同种异体肌腱双束重建膝关节内侧髌股韧带结合髌韧带止点内移治疗重度髌骨脱位的临床疗效。
方法:自2008年9月至2013年6月,收治重度髌骨脱位16例,男2例,女14例;年龄11～27岁,平均16岁;左膝11例,右膝5例;病程3～10年。16例均为习惯性脱位,屈膝时髌骨自动向外脱出。脱位次数9～33次,平均19次。患膝关节髌骨不稳,髌骨向外侧活动度明显增大,恐惧征阳性。X线片见髌骨脱位,髌股适合角(63±18)°,Q 角(36±9)°。根据 Kujala 等的髌股关节评分标准,总评分45.20±9.20.术中重建内侧髌股韧带,并联合外侧韧带松解、髌腱止点内移或股四头肌腱力线重排。内侧髌股韧带重建方法:采用髌骨横向钻孔,同种异体肌腱横穿髌骨后反折双束编织,并以挤压钉固定于股骨内髁。
结果:术后16例切口全部Ⅰ期愈合,未发生感染及移植物坏死、吸收。术后6周拆除石膏,开始功能训练。患者术后均获随访,时间10～24个月,平均16.4个月。末次随访时患者无膝关节疼痛、肿胀及髌骨不稳,无习惯髌骨脱位及髌骨骨折。术后 6个月X线片示挤压钉及隧道位置良好,髌股适合角(5±9)°,较术前减小。末次随访时Q角(17±8)°,较术前减小;髌股关节总评分89.30±6.40,较术前提高。
结论:同种异体肌腱双束解剖重建膝关节内侧髌股韧带治疗髌骨脱位能恢复髌骨内侧稳定结构,避免自体肌腱切取造成的损伤,挤压钉固定能增强重建韧带的稳定性。但术中使用挤压钉、同种异体肌腱,增加了手术成本 |
| [关键词]:髌骨 脱位 内侧髌股韧带 同种异体肌腱 |
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| Anatomical double bundle reconstruction of medial patellofemoral ligament with allograft tendon in the treatment of patellar dislocations |
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Abstract:
Objective:To investigate the clinical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral ligament(MPFL) for the treatment of patellar dislocations.
Methods:From September 2008 to June 2013,16 patients with patellar dislocation underwent MPFL reconstructions. There were 2 males and 14 females,aged 11 to 27 years old(16 years old on average). Patellar dislocations occurred in 11 left and 5 right knees. The disease course ranged from 3 to 10 years. The frequency of dislocation ranged from 9 to 33 times(19 times on average). Affected knee joints showed patellar instability; the range of action for patella obviously increased. The X-ray films showed patellar dislocation. The preoperative Q angle was (36 ± 9)°,and the congruence angle was (63 ± 18)°。 Reconstruction was performed via allograft tendon. Allograft tendon was fixed through the superomedial pole of the patella,and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All the patients were evaluated postoperatively;Kujala patellofemoral scores,objective knee function,complications,and reoperations were assessed.
Results:Primary healing was achieved in all cases. No infection or necrosis and absorption of grafts was observed. All the patients were followed up for an average of 16.4 months (ranged,10 to 24 months) postoperatively. At the latest follow-up,all the patients had no pain,swelling and patellar instability; neither patella redislocation nor fracture occurred. The X-ray films showed good position of tunnel 6 months after operation,and the congruence angle was (5±9)°,showing statistically significant difference when compared with preoperation (P<0.05). The postoperative Q angle was (17 ± 8)°,the Kujala knee function score improved significantly from 45.20±9.20 to 89.30±6.40 at the latest follow-up,showing statistically significant difference(P<0.05).
Conclusion:MPFL reconstruction improves clinical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation,and it offers good recovery of the premorbid patella mechanics. The interference screw provides firm fixation. Allograft can avoid the graft harvest site morbidity,but it increases the cost of the surgery. |
| KEYWORDS:Patellar Dislocations Medial patellofemoral ligament Allograft tendon |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 唐辉,徐永清,郑天娥,沙勇,徐小山,赵万秋,崔勇,张曦娇,浦绍全,李川,李春晓.同种异体肌腱重建内侧髌股韧带治疗习惯性髌骨脱位[J].中国骨伤,2015,28(3):252~255 |
| 英文格式: | TANG Hui,XU Yong-qing,ZHENG Tian-e,SHA Yong,XU Xiao-shan,ZHAO Wan-qiu,CUI Yong,ZHANG Xi-jiao,PU Shao-quan,LI Chuan,LI Chun-xiao.Anatomical double bundle reconstruction of medial patellofemoral ligament with allograft tendon in the treatment of patellar dislocations[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(3):252~255 |
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