Li Yuan, Liu Juncai, Lei Lei, Zhou Peng, Deng Fuyuan, Li Zhong
Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China.
Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Mar 15;35(3):343-348. doi: 10.7507/1002-1892.202009111.
To investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°).
Between June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively.
All incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation ( <0.05).
DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.
探讨股骨远端去旋转截骨术（DDFO）联合髌股内侧韧带（MPFL）重建术治疗股骨前倾角过大（FAA≥30°）的复发性髌骨脱位的短期疗效。
2017年6月至2019年8月，对17例FAA≥30°的复发性髌骨脱位患者行DDFO及MPFL重建术。其中男性5例，女性12例，年龄14 - 22岁，平均17.7岁。髌骨脱位2 - 8次（平均3.6次）。病程2 - 7年（平均4.6年）。髌骨恐惧试验均为阳性。术前疼痛视觉模拟评分（VAS）、Lysholm评分、Tegner评分及Kujala评分分别为4.2±1.1、47.8±8.1、3.6±1.1及56.8±5.7。FAA、股骨远端机械外侧角（mLDFA）、髌骨外侧移位（LPD）、胫骨结节 - 滑车沟距离（TT - TG）分别为（34.9±3.4）°、（85.8±3.0）°、（13.7±3.8）mm及（23.1±2.1）mm。
所有切口均一期愈合，未出现膝关节僵硬、感染及髌骨再脱位等并发症。所有患者均获随访13 - 25个月，平均17.7个月。影像学复查显示，1例截骨未愈合，二次翻修及加强固定后效果满意；其余患者截骨术后3 - 4个月完全愈合。髌骨恐惧试验均为阴性。末次随访时，FAA、mLDFA、LPD及TT - TG分别为（15.6±2.7）°、（83.0±2.1）°、（5.0±2.6）mm及（20.5±2.5）mm；VAS评分、Lysholm评分、Tegner评分及Kujala评分分别为2.4±1.4、93.4±7.8、6.8±1.5及89.0±8.0。上述指标术前与术后比较差异有统计学意义（<0.05）。
DDFO联合MPFL重建术治疗FAA过大（≥30°）的复发性髌骨脱位可取得良好的短期疗效，显著减轻膝关节疼痛，改善膝关节功能。
