Deie Masataka, Ochi Mitsuo, Sumen Yoshio, Adachi Nobuo, Kobayashi Kenji, Yasumoto Masanori
Graduate School of Biomedical Sciences, Department of Orthopaedic Surgery, Hiroshima University, Minami-ku, Hiroshima, Japan.
Knee Surg Sports Traumatol Arthrosc. 2005 Oct;13(7):522-8. doi: 10.1007/s00167-005-0641-x. Epub 2005 Jun 21.
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 Insall's 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 Kujala's 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 Insall's procedure might be recommended for the treatment of habitual, recurrent, and indeed any other type of patellar dislocation, as well as for unstable patellae.
传统上，髌骨脱位综合征的治疗颇具难度。由于病因众多，目前尚无治疗髌骨脱位的金标准方法。然而，已知髌骨脱位时内侧髌股韧带（MPFL）会受损。本研究的目的是检验我们的MPFL重建方法对治疗髌骨脱位和髌骨不稳定是否有效。对68例膝关节（65例患者）中的46例膝关节（43例患者）进行了随访，这些膝关节采用了我们的手术方法，即通过股内侧肌推进进行MPFL重建或采用Insall手术进行MPFL重建，随访时间至少为5年。患者年龄在6至43岁之间。这些膝关节包括6例习惯性髌骨脱位、26例复发性髌骨脱位、10例创伤性髌骨脱位和4例髌骨不稳定。对患者进行了术前评估，并在术后6、12、36、60或120个月进行了三次以上的术后评估。术后无患者发生髌骨脱位。他们的术后库贾拉评分显著提高。在传统X线和应力X线评估中，末次随访（60或120个月）时的一致性角、倾斜角、外侧移位率、内侧应力移位率和外侧应力移位率的平均值均在正常范围内。我们得出结论，对于习惯性、复发性以及任何其他类型的髌骨脱位以及髌骨不稳定的治疗，推荐采用我们通过股内侧肌推进或采用Insall手术进行的MPFL重建方法。
