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

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
作者：陈浩,黄伟,梁熙,胡宁
【摘要】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 of patella，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。

【关键词】髌骨脱位;髌股韧带;人工韧带;关节镜
【Abstract】 Objective To investigate the clinic effect of the arthroscopic reconstruction of medial patellofemoral ligament(MPFL) with LARS artificial ligament in the treatment of recurrent dislocation of patella(RDP).Methods Six cases of RDP were treated by arthroscopic reconstruction of MPFL with
LARS artificial ligament from Mar.2007 to condition of patellofemoral joint and MPFL were detected with X ray,CT and MRI preoperatively.The arthroscopic examination was undertaken before the reconstruction to observe the patellofemoral congruence and the patellar track,as well as articular cartilage.The MPFL was reconstructed with LARS artificial ligament.Then arthroscopic examination was taken again to measure the patellofemoral congruence and patellar track after the reconstruction.Functional training in knee joint was applied and subjective symptoms were scored postoperatively.Results No infection,graft rejection and rupture were observed in all cases.Patients were followed up for 624 months (ranging 13 months).All knees function were evaluated with Install's standard postoperatively,showing excellent in 5 cases,good in 1 case.X ray measurement indicated excellent patella reduction without recurrence of dislocation or subluxaion.Conclusion It is effective to treat RDP by way of reconstruction of MPFL with LARS artificial ligament under guide of arthroscopy.
【Key words】patellar dislocation;patellofemoral ligament;artificial ligament;arthroscopy
复发性髌骨脱位(RDP)治疗效果报道不一，大多数学者建议采
用手术治疗[1]。

目前约有 100多种用于治疗RDP的手术方法，其目的都是为了控制髌骨不稳，恢复髌骨的正常运动轨道。

近年来，重建内侧髌股韧带(MPFL)对治疗RDP取得良好的临床效果[2-5]。

我科自2007年3月～2008年7月在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MPFL 治疗RDP，临床效果良好，现报告如下。

临床资料
1 一般资料
本组RDP 6例(其中1例为双膝)，男性1例，女性5例;年龄14～28岁，平均17岁。

患者术前述膝前呈持续性钝痛，上下楼梯时明显，膝关节有不稳、发软或踏空感，5例有髌骨摩擦感、膝关节肿胀史及跌倒史。

查体：髌周压痛，内侧为主，恐惧试验阳性，5例髌骨研磨和滑动试验阳性，髌骨倾斜试验阴性。

2 影像学检查
所有患者术前均行膝关节正侧位片和髌骨轴位片、CT和MRI，测定滑车沟角(sulcus angle，SA)、髌股适合角(congruence angle，CA)、外侧髌股角(lateral patellofemoral angle，LPFA)和髌骨倾斜角(patellar tilt angle，PTA)，初步了解髌股关节和股骨髁发育情况;髌股关节软骨及周围软组织支持结构损伤程度。

所选病例股骨滑车分级为A、B、C型[6]。

3 手术方法
麻醉成功后,先行关节镜检查膝关节屈伸运动时髌股关节对。