摘要
目的探讨穿骨缝线回植固定治疗合并髌骨骨软骨骨折(osteochondral fractures,OCFs)的复发性急性髌骨脱位近期疗效。方法回顾分析2018年1月—2022年12月19例复发性急性髌骨脱位合并OCFs患者临床资料,均接受穿骨缝线回植固定治疗且随访达2年。男8例,女11例;年龄13~21岁,平均16.2岁。患者髌骨脱位2~5次,平均3.2次。末次脱位至手术时间3~15 d,平均9.6 d。术前影像学检查可见关节腔内游离骨软骨骨块、内侧髌股韧带(medial patellofemoral ligament,MPFL)损伤。手术前后采用疼痛视觉模拟评分(VAS)、国际膝关节文献委员会(IKDC)评分、美国特种外科医院(HSS)评分、Lysholm评分、Tegner评分评价膝关节疼痛以及功能情况,观察术后并发症发生情况。复查膝关节X线片、CT及MRI,评估骨软骨骨块有无脱离、移位及其愈合以及MPFL重建移植物形态、张力情况。结果术后切口均Ⅰ期愈合,无感染、关节僵硬、髌股关节炎等并发症发生以及髌骨脱位复发。患者均获随访,随访时间24~60个月,平均43.5个月。术后12个月及末次随访时VAS评分、Lysholm评分、IKDC评分、HSS评分及Tegner评分均较术前改善,末次随访时较术后12个月进一步改善,差异有统计学意义(P<0.05)。影像学复查示,骨软骨骨块位置满意、固定良好,末次随访时均愈合且MPFL重建移植物形态、张力良好;未出现关节粘连及骨块移位。结论穿骨缝线回植固定治疗合并髌骨OCFs的复发性急性髌骨脱位安全、有效,可获得较好近期疗效。
Objective To evaluate the early effectiveness of transosseous suture fixation in treating recurrent acute patellar dislocation with patellar osteochondral fractures(OCFs).Methods A retrospective analysis was conducted on 19 patients with recurrent acute patellar dislocation and patellar OCFs,who underwent transosseous suture fixation between January 2018 and December 2022 and were followed up 2 years.The cohort included 8 males and 11 females,aged 13-21 years(mean,16.2 years).Patients experienced 2-5 times of patellar dislocation(mean,3.2 times).The interval from the last dislocation to operation ranged from 3 to 15 days(mean,9.6 days).Preoperative imaging revealed the intraarticular osteochondral fragments and medial patellofemoral ligament(MPFL)injury.Clinical outcomes were evaluated using the visual analogue scale(VAS)score for pain,the International Knee Documentation Committee(IKDC)score,the Hospital for Special Surgery(HSS)knee score,the Lysholm score,and the Tegner score.Postoperative complications were recorded.During follow-up,the knee X-ray films,CT,and MRI were taken to evaluate fragment healing,displacement,and the morphology and tension of the MPFL reconstruction graft.Results All incisions healed primarily,and no complication occurred such as infection,joint stiffness,patellofemoral arthritis,or redislocation.Patients were followed up 24-60 months(mean,43.5 months).At 12 months postoperatively and the last follow-up,significant improvements(P<0.05)were observed in VAS,Lysholm,IKDC,HSS,and Tegner scores compared to preoperative values.Further improvements were observed at last follow-up compared with the 12 months postoperatively,and the differences were significant(P<0.05).Imaging studies demonstrated satisfactory osteochondral fragment positioning with stable fixation.At last follow-up,all fragments had healed,and MPFL reconstruction grafts exhibited optimal morphology and tension.No joint adhesion or fragment displacement occurred.Conclusion For recurrent acute patellar dislocation with patellar OCFs,transosseous suture fixation proves to be both safe and effective,achieving satisfactory early effectiveness.
作者
刘俊良
翟龙祥
许镇木
吴澳秋
周鼎
贺雨晨
刘骞
唐琪
朱威宏
LIU Junliang;ZHAI Longxiang;XU Zhenmu;WU Aoqiu;ZHOU Ding;HE Yuchen;LIU Qian;TANG Qi;ZHU Weihong(Department of Orthopedics,the Second Xiangya Hospital of Central South University,Changsha Hunan,410011,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第7期831-836,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
复发性髌骨脱位
髌骨骨软骨骨折
内侧髌股韧带重建
穿骨缝线
Recurrent patellar dislocation
patellar osteochondral fracture
medial patellofemoral ligament reconstruction
transosseous suture
