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-  2015 

胫骨结节内旋技术在治疗伴股骨滑车发育不良的复发性髌骨脱位中的作用

DOI: doi:10.7507/1002-1892.20150008

Keywords: 复发性髌骨脱位, 胫骨结节内旋技术, 滑车发育不良

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Abstract:

目的探讨胫骨结节内旋技术在治疗伴股骨滑车发育不良的复发性髌骨脱位中的作用。 方法2007年2月-2011年4月,收治28例伴股骨滑车发育不良的复发性髌骨脱位患者。男4例,女24例;年龄17~28岁,平均21.8岁。病程6个月~8年,平均4年。脱位3~10次。患者恐惧试验阳性,Lysholm评分为(51.64±3.79)分,Kujala评分为(56.89±3.79)分。滑车发育不良根据Dejour分型标准:B型11例、C型14例、D型3例;胫骨结节-股骨滑车沟间距(tibial tuberosity-trocholear distance,TT-TG)值为(20.53±2.58)mm,髌骨倾斜角(patellar tilt angle,PTA)为(29.34±2.54)°。术中采用改良Fulkerson方法行胫骨结节截骨,并通过内移、内旋、抬高技术调整髌股关系,联合自体半腱肌腱解剖重建内侧髌股韧带。 结果术后除1例切口轻度感染外,其余切口均Ⅰ期愈合。27例患者获随访,随访时间27~74个月,平均41.8个月。术后患者均无髌骨再脱位,恐惧试验阴性。膝关节屈伸活动度均恢复正常。末次随访时,Kujala评分为(88.97±3.06)分,Lysholm评分为(88.95±2.98)分,均较术前显著提高(t=-42.005,P=0.000;t=-43.122,P=0.000)。末次随访时TT-TG值、PTA均恢复至正常范围,分别为(11.77±2.24)mm以及(7.99±2.57)°,与术前比较差异均有统计学意义(t=13.032,P=0.000;t=29.533,P=0.000)。 结论对于伴股骨滑车发育不良的复发性髌骨脱位,采用胫骨结节移位联合内侧髌股韧带重建治疗可以恢复髌骨稳定性,改善膝关节功能,临床疗效较好。尤其通过胫骨结节内旋技术可有效改善髌股关节对合关系和髌骨运动轨迹,增加髌股关节匹配

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