Li Li, Wang Hongbo, He Yun, Si Yu, Zhou Hongyu, Wang Xin
The Third Department of Orthopedics, Hospital of Traditional Chinese Medicine of Xinjiang Medical University, Urumqi, Xinjiang 830002, P.R. China.
Exp Ther Med. 2018 Jun;15(6):5051-5057. doi: 10.3892/etm.2018.6055. Epub 2018 Apr 12.
Recurrent patellar dislocations were treated via knee arthroscopy combined with C-arm fluoroscopy, and reconstruction of the medial patellofemoral ligaments. Between October 2013 and March 2017, 52 cases of recurrent patellar dislocation [27 males and 25 females; age, 16-47 years (mean, 21.90 years)] were treated. Arthroscopic exploration was performed and patellofemoral joint cartilage injuries were repaired. It was subsequently determined whether it was necessary to release the lateral patellofemoral support belt. Pre-operative measurements were used to decide whether tibial tubercle osteotomy was required. Medial patellofemoral ligaments were reconstructed using autologous semitendinosus tendons. Smith and Nephew model 3.5 line anchors were used to double-anchor the medial patellofemoral margin. On the femoral side, the medial patellofemoral ligament was fixed using 7-cm, absorbable, interfacial compression screws. All cases were followed for 1-40 months (average, 21 months). The Q angle, tibial tuberosity trochlear groove distance, Insall-Salvati index, patellofemoral angle, lateral patellofemoral angle and lateral shift were evaluated on X-Ray images using the picture archiving and communication system. Subjective International Knee Documentation Committee (IKDC) knee joint functional scores and Lysholm scores were recorded. Post-operative fear was absent, and no patellar re-dislocation or re-fracture was noted during follow-up. At the end of follow-up, the patellofemoral angle (0.22±4.23°), lateral patellofemoral angle (3.44±1.30°), and lateral shift (0.36+0.14°) differed significantly from the pre-operative values (all, P<0.05). Furthermore, IKDC and Lysholm scores (87.84+3.74 and 87.48+3.35, respectively) differed significantly from the pre-operative values (both, P<0.05). These findings suggest that, in the short term, recurrent patellar dislocation treatment via knee arthroscopy combined with C-arm fluoroscopy and reconstruction of the medial patellofemoral ligament was effective.
复发性髌骨脱位采用膝关节镜联合C型臂透视及髌股内侧韧带重建术进行治疗。在2013年10月至2017年3月期间，共治疗了52例复发性髌骨脱位患者[男性27例，女性25例；年龄16 - 47岁（平均21.90岁）]。进行了关节镜探查并修复了髌股关节软骨损伤。随后确定是否需要松解髌股外侧支持带。术前测量用于决定是否需要进行胫骨结节截骨术。采用自体半腱肌腱重建髌股内侧韧带。使用史赛克3.5线锚钉对髌股内侧缘进行双锚定。在股骨侧，使用7厘米可吸收界面加压螺钉固定髌股内侧韧带。所有病例随访1 - 40个月（平均21个月）。使用图像存档与通信系统在X线图像上评估Q角、胫骨结节 - 滑车沟距离、Insall - Salvati指数、髌股角、髌股外侧角和外侧移位。记录主观国际膝关节文献委员会（IKDC）膝关节功能评分和Lysholm评分。术后无恐惧感，随访期间未发现髌骨再次脱位或再骨折。随访结束时，髌股角（0.22±4.23°）、髌股外侧角（3.44±1.30°）和外侧移位（0.36 + 0.14°）与术前值相比差异有统计学意义（均P<0.05）。此外，IKDC和Lysholm评分（分别为87.84 + 3.74和87.48 + 3.35）与术前值相比差异有统计学意义（均P<0.05）。这些结果表明，短期内，通过膝关节镜联合C型臂透视及髌股内侧韧带重建术治疗复发性髌骨脱位是有效的。
