Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China.
Chin Med J (Engl). 2010 Nov;123(21):3024-9.
The medial patellofemoral ligament (MPFL) reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement.
We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008: twenty eight cases with isolated MPFL reconstruction (group I), forty one cases with the combination of MPFL reconstruction with vastus medialis advancement (group C). All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires.
Patients were followed up for a mean of 42 months (12 - 65 months) without a recurrent dislocation reported. Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group I and three in group C had patellar lateral shift exceeding 1.5 cm with a hard end point (P < 0.05). The Kujala score improved significantly from 51.3 ± 4.5 to 79.9 ± 6.2 in group I and from 53.7 ± 5.2 to 83.9 ± 6.5 in group C (P > 0.05). However, the subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, seven good and nine fair in group I and 30 excellent, six good and five fair in group C.
The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.
内侧髌股韧带（MPFL）重建术在临床实践中常用于慢性髌骨脱位；然而，与股内侧肌前向推进术联合应用的情况较为少见。本研究旨在评估 MPFL 重建术联合股内侧肌前向推进术的临床疗效。
我们回顾性分析了 2004 年 7 月至 2008 年 10 月间 69 例慢性髌骨脱位患者：28 例行单纯 MPFL 重建术（I 组），41 例行 MPFL 重建术联合股内侧肌前向推进术（C 组）。所有患者均行膝关节 30°屈曲位 CT 扫描，测量髌股关节吻合角、髌骨倾斜角和髌骨外侧移位。检查物理检查的感知测试并记录复发性脱位。此外，使用 Kujala 评分和主观问卷调查评估膝关节功能。
患者平均随访 42 个月（12-65 个月），无复发性脱位。术后 CT 扫描所有指标均在正常范围内，两组间无统计学差异。感知测试结果显示，I 组有 8 例和 C 组有 3 例髌骨外侧移位超过 1.5cm 且有硬性终末点（P<0.05）。I 组的 Kujala 评分从 51.3±4.5 显著改善至 79.9±6.2，C 组从 53.7±5.2 显著改善至 83.9±6.5（P>0.05）。然而，主观问卷调查结果存在显著差异（P<0.05），I 组 12 例优，7 例良，9 例可，C 组 30 例优，6 例良，5 例可。
MPFL 重建术联合股内侧肌前向推进术可改善慢性髌骨脱位的主观疗效，降低髌骨不稳定发生率。
