Cai Guofeng, Li Yanlin, Ning Ziwen, Han Rui, Jia Di, Li Song, Song En, Wang Xu
Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Aug 15;36(8):963-968. doi: 10.7507/1002-1892.202201087.
To explore the mid-term effectiveness of combined knee extensor mechanism realignment with bone anchor for recurrent patella dislocation.
Between August 2017 and May 2019, 21 patients with recurrent patella dislocation underwent combined knee extensor mechanism realigament with bone anchor and followed up more than 3 years. There were 8 males and 13 females with an average age of 19.4 years (range, 13-26 years). All 21 patients had a history of recurrent patellar dislocation for 2-5 times (median, 3 times), and the disease duration was 1-16 years (mean, 5 years). The preoperative Lysholm score was 67.5±6.3 and the Kujula score was 64.1±7.0. The defect of meniscus, anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments were excluded by MRI examination; CT examination showed that the tibial tuberosity-trochlear groove distance was 2.05-2.56 cm, with an average of 2.16 cm; X-ray examination showed that lower limb force line was abnormal. The effectiveness were evaluated by Lysholm score and Kujula score before operation and at 3 years after operation, and Insall evaluation standard at 3 years after operation.
All the incisions healed by first intention, and there was no surgical complication such as lower extremity deep vein thrombosis, incision infection, and nerve injury. All 21 patients were followed up 3.0-3.5 years, with an average of 3.2 years. Anteroposterior and lateral X-ray films of the knee joint at 3 years after operation showed that the position of the patella was normal, and the axial X-ray films of the patella (30°, 60°, 90°) showed that the patellofemoral joint had a good relationship. During the follow-up, there was no anchor drop or fracture, no obvious pseudarthrosis formation, and no epiphyseal injury in the minor patients. The Lysholm score was 91.5±7.1 and the Kujula score was 88.1±7.6 at 3 years after operation, which were significantly improved when compared with those before operation ( =11.57, =0.00; =12.78, =0.00). According to the Insall evaluation criteria, 12 cases were excellent, 4 cases were good, 4 cases were fair, and 1 case was poor, with an excellent and good rate of 76.2%.
Combined knee extensor mechanism realignment with bone anchor is a simple and reliable way to treat the recurrent patella dislocation, with a satisfactory mid-term effectiveness and less complications; however, its long-term effectiveness needs further follow-up.
探讨采用骨锚进行膝关节伸肌机制联合重建治疗复发性髌骨脱位的中期疗效。
2017年8月至2019年5月，21例复发性髌骨脱位患者接受了骨锚膝关节伸肌机制联合重建术，并进行了3年以上的随访。其中男性8例，女性13例，平均年龄19.4岁（13 - 26岁）。21例患者均有复发性髌骨脱位病史2 - 5次（中位数3次），病程1 - 16年（平均5年）。术前Lysholm评分为67.5±6.3，Kujula评分为64.1±7.0。通过MRI检查排除半月板、前后交叉韧带以及内外侧副韧带损伤；CT检查显示胫骨结节 - 滑车沟距离为2.05 - 2.56 cm，平均为2.16 cm；X线检查显示下肢力线异常。采用术前及术后3年的Lysholm评分和Kujula评分，以及术后3年的Insall评估标准进行疗效评价。
所有切口均一期愈合，未发生下肢深静脉血栓、切口感染、神经损伤等手术并发症。21例患者均获随访3.0 - 3.5年，平均3.2年。术后3年膝关节正侧位X线片显示髌骨位置正常，髌骨轴位X线片（30°、60°、90°）显示髌股关节关系良好。随访期间，未出现锚钉松动或断裂，无明显假关节形成，未成年患者无骨骺损伤。术后3年Lysholm评分为91.5±7.1，Kujula评分为88.1±7.6，与术前相比差异有统计学意义（ =11.57， =0.00； =12.78， =0.00）。根据Insall评估标准，优12例，良4例，可4例，差1例，优良率为76.2%。
采用骨锚进行膝关节伸肌机制联合重建是治疗复发性髌骨脱位的一种简单可靠的方法，中期疗效满意，并发症较少；但其长期疗效仍需进一步随访观察。
