關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位_《中國修復重建外科雜志》

作者：

趙波 ¹ , 冉霞 ² , 張銘華 ¹ , 何超 ¹ , 蔣電明 ³

重慶醫科大學附屬永川醫院（重慶永川，402160）1骨科，2腎內科;;
3 重慶醫科大學附屬第一醫院骨科;

關鍵詞：

急性髕骨脫位髕骨內側支持帶緊縮術關節鏡青少年

DOI：

10.7507/1002-1892.20130315

視頻：

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目的探討關節鏡下髕骨內側支持帶緊縮術（medial retinaculum plication，MRP）治療青少年急性髕骨脫位（acute patellar dislocation，APD）的臨床療效。方法2007年3月－2011年6月，對24例青少年APD患者采用關節鏡下MRP治療。男14例，女10例；年齡8～18歲，平均12.7歲。左膝16例，右膝8例。致傷原因：運動傷19例，交通事故傷4例，重物砸傷1例。髕骨脫位至手術時間3～21 d，平均7.8 d。浮髕試驗陽性，脫位恐懼試驗陽性。MRI示均見關節腔積液，合并內側支持帶結構損傷20例，髕骨內側面骨挫傷8例，半月板破裂5例。結果術后切口均Ⅰ期愈合，無感染及神經、血管損傷等早期并發癥發生。患者均獲隨訪，隨訪時間12～36個月，平均 14.6個月。術后4個月及6個月各1例發生再脫位。術后12個月患者膝關節活動度恢復正常。術后3、12個月Lysholm評分、Kujala評分及國際膝關節文獻委員會（IKDC）評分均較術前顯著提高，術后12個月高于3個月，比較差異均有統計學意義（P lt; 0.05）。結論關節鏡下MRP治療青少年APD具有創傷小、膝關節功能恢復好的優點，術后脫位復發率低。

引用本文： 趙波,冉霞,張銘華,何超,蔣電明. 關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位. 中國修復重建外科雜志, 2013, 27(12): 1437-1441. doi: 10.7507/1002-1892.20130315 復制

1.	陳堅, 倪磊, 呂厚山. 急性髕骨脫位的關節鏡下診斷與治療. 中華骨科雜志, 2006, 26(8): 505-508.
2.	Apostolovic M, Vukomanovic B, Slavkovic N, et al. Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop, 2011, 35(10): 1483-1487.
3.	Balcarek P, Jung K, Ammon J, et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med, 2010, 38(11): 2320-2327.
4.	Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
5.	Smith TO, Song F, Donell ST, et al. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 988-998.
6.	Philippot R, Boyer B, Testa R, et al. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 331-336.
7.	Bedi H, Marzo J. The biomechanics of medial patellofemoral ligament repair followed by lateral retinacular release. Am J Sports Med, 2010, 38(7): 1462-1467.
8.	Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am, 2003, 34(3): 385-396.
9.	Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 7-12.
10.	Wang F, Kang HJ, Chen BC, et al. Combination of medial patellofemoral ligament reconstruction with vastus medialis advance-ment for chronic patellar dislocation. Chin Med J, 2010, 123(21): 3024-3029.
11.	Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
12.	Camanho GL, Viegas Ade C, Bitar AC, et al. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy, 2009, 25(6): 620-625.
13.	Petri M, Liodakis E, Hofmeister M, et al. Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg, 2013, 133(2): 209-213.
14.	Deie M, Ochi M, Sumen Y, et al. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg (Br), 2003, 85(6): 887-890.
15.	馮超, 王玉琨, 張建立, 等. 大收肌腱移位重建內側髕股韌帶治療兒童復發性髕骨脫位初期效果分析. 中華小兒外科雜志, 2012, 33(6): 429-433.
16.	Zhao J, Huangfu X, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med, 2012, 40(1): 123-132.
17.	Ji G, Wang F, Zhang Y, et al. Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop, 2012, 36(9): 1819-1825.
18.	Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop, 1999, 23(5): 260-263.
19.	Sanders TG, Morrison WB, Singleton BA, et al. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr, 2001, 25(6): 957-962.
20.	White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis, 2009, 67(1): 22-29.
21.	Tom A, Fulkerson JP. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med Arthrosc, 2007, 15(2): 68-71.
22.	Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg, 2004, 17(1): 47-56.
23.	徐才祺, 趙金忠. 關節鏡下髕骨內側支持帶緊縮術治療青少年復發性髕骨脫位. 中國修復重建外科雜志, 2011, 25(8): 931-936.

1. 陳堅, 倪磊, 呂厚山. 急性髕骨脫位的關節鏡下診斷與治療. 中華骨科雜志, 2006, 26(8): 505-508.
2. Apostolovic M, Vukomanovic B, Slavkovic N, et al. Acute patellar dislocation in adolescents: operative versus nonoperative treatment. Int Orthop, 2011, 35(10): 1483-1487.
3. Balcarek P, Jung K, Ammon J, et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med, 2010, 38(11): 2320-2327.
4. Nietosvaara Y, Aalto K, Kallio PE. Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop, 1994, 14(4): 513-515.
5. Smith TO, Song F, Donell ST, et al. Operative versus non-operative management of patellar dislocation. A meta-analysis. Knee Surg Sports Traumatol Arthrosc, 2011, 19(6): 988-998.
6. Philippot R, Boyer B, Testa R, et al. The role of the medial ligamentous structures on patellar tracking during knee flexion. Knee Surg Sports Traumatol Arthrosc, 2012, 20(2): 331-336.
7. Bedi H, Marzo J. The biomechanics of medial patellofemoral ligament repair followed by lateral retinacular release. Am J Sports Med, 2010, 38(7): 1462-1467.
8. Hinton RY, Sharma KM. Acute and recurrent patellar instability in the young athlete. Orthop Clin North Am, 2003, 34(3): 385-396.
9. Panagiotopoulos E, Strzelczyk P, Herrmann M, et al. Cadaveric study on static medial patellar stabilizers: the dynamizing role of the vastus medialis obliquus on medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc, 2006, 14(1): 7-12.
10. Wang F, Kang HJ, Chen BC, et al. Combination of medial patellofemoral ligament reconstruction with vastus medialis advance-ment for chronic patellar dislocation. Chin Med J, 2010, 123(21): 3024-3029.
11. Sillanpää P, Mattila VM, Iivonen T, et al. Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc, 2008, 40(4): 606-611.
12. Camanho GL, Viegas Ade C, Bitar AC, et al. Conservative versus surgical treatment for repair of the medial patellofemoral ligament in acute dislocations of the patella. Arthroscopy, 2009, 25(6): 620-625.
13. Petri M, Liodakis E, Hofmeister M, et al. Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg, 2013, 133(2): 209-213.
14. Deie M, Ochi M, Sumen Y, et al. Reconstruction of the medial patellofemoral ligament for the treatment of habitual or recurrent dislocation of the patella in children. J Bone Joint Surg (Br), 2003, 85(6): 887-890.
15. 馮超, 王玉琨, 張建立, 等. 大收肌腱移位重建內側髕股韌帶治療兒童復發性髕骨脫位初期效果分析. 中華小兒外科雜志, 2012, 33(6): 429-433.
16. Zhao J, Huangfu X, He Y, et al. Recurrent patellar dislocation in adolescents: medial retinaculum plication versus vastus medialis plasty. Am J Sports Med, 2012, 40(1): 123-132.
17. Ji G, Wang F, Zhang Y, et al. Medial patella retinaculum plasty for treatment of habitual patellar dislocation in adolescents. Int Orthop, 2012, 36(9): 1819-1825.
18. Nomura E. Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Int Orthop, 1999, 23(5): 260-263.
19. Sanders TG, Morrison WB, Singleton BA, et al. Medial patellofemoral ligament injury following acute transient dislocation of the patella: MR findings with surgical correlation in 14 patients. J Comput Assist Tomogr, 2001, 25(6): 957-962.
20. White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis, 2009, 67(1): 22-29.
21. Tom A, Fulkerson JP. Restoration of native medial patellofemoral ligament support after patella dislocation. Sports Med Arthrosc, 2007, 15(2): 68-71.
22. Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg, 2004, 17(1): 47-56.
23. 徐才祺, 趙金忠. 關節鏡下髕骨內側支持帶緊縮術治療青少年復發性髕骨脫位. 中國修復重建外科雜志, 2011, 25(8): 931-936.

《中國修復重建外科雜志》

關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位

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《中國修復重建外科雜志》

關節鏡下髕骨內側支持帶緊縮術治療青少年急性髕骨脫位

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