Rillmann P, Dutly A, Kieser C, Berbig R
Chirurgisch-Orthopädische Klinik, Spital Davos, Davos-Platz, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 1998;6(1):31-5. doi: 10.1007/s001670050069.
The purpose of this study was to determine whether or not the modified medial transfer of the ligamentum patellae in case of objective instability of the patella is an adequate therapy and if it is possible to improve the patellar congruence angle by this method. Between October 1987 and April 1993, 41 operations were performed in 37 patients with medialization of the medial third of the ligamentum patellae with the corresponding part of the tibial tubercule. Four patients needed a bilateral operation; the two interventions were not performed at the same time. Thirty-six operated knees (88%) were examined at a median clinical and radiological follow-up of 62.8 months (+/- 15.8 SD). For evaluation, the objective and subjective Turba score was used, and pre- and postoperative X-rays were compared. The patients' average age at the time of intervention was 23.2 years (+/- 7 years SD). The operation was performed 39 times for recurrent dislocation or subluxation, for patella alta with cartilage tissue damage, and for first time traumatic dislocation. The only postoperative complication was a temporary peroneal paresis. There were no redislocations seen at the follow-up. One patient with repeated subluxations underwent an additional lateral release combined with a repair of the medial retinaculum. In all other cases, the Turba score showed good or excellent results (subjective 1.9; objective 0.8), the patellar congruence angle was significantly improved (P < 0.001), and there were no medial subluxations. We conclude that the transfer of the medial third of the ligamentum patellae for objective instability of the patella is a minimally invasive and adequate technique to improve significantly a pathological patellar congruence angle.
本研究的目的是确定在髌骨客观不稳定的情况下，改良的髌韧带内侧转移术是否为一种充分的治疗方法，以及通过该方法是否有可能改善髌股适合角。1987年10月至1993年4月期间，对37例患者进行了41次手术，将髌韧带内侧三分之一与胫骨结节相应部分进行内移。4例患者需要双侧手术；两次手术并非同时进行。对36个接受手术的膝关节（88%）进行了临床和放射学随访，中位随访时间为62.8个月（标准差±15.8）。为进行评估，采用了客观和主观的Turba评分，并比较了术前和术后的X线片。干预时患者的平均年龄为23.2岁（标准差±7岁）。该手术针对复发性脱位或半脱位、伴有软骨组织损伤的高位髌骨以及首次创伤性脱位进行了39次。术后唯一的并发症是暂时性腓总神经麻痹。随访期间未见再脱位。1例反复半脱位的患者接受了额外的外侧松解术并联合内侧支持带修复术。在所有其他病例中，Turba评分显示为良好或优秀结果（主观评分为1.9；客观评分为0.8），髌股适合角显著改善（P < 0.001），且无内侧半脱位。我们得出结论，对于髌骨客观不稳定，髌韧带内侧三分之一转移术是一种微创且充分的技术，可显著改善病理性髌股适合角。
