自体腘绳肌与腓骨长肌双束解剖重建内侧髌股韧带疗效分析

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摘要目的比较关节镜下应用自体腘绳肌腱与自体腓骨肌腱双束解剖重建内侧髌股韧带的临床疗效。方法回顾性分析2017年1月至2019年5月在新疆医科大学第六附属医院行双束解剖重建内侧髌股韧带的55例患者，根据移植物不同分为两组，A组男性13例，女性17例；平均年龄(22.83±10.84)岁，采用自体腘绳肌腱移植。B组男性11例，女性14例；平均年龄(21.28±6.95)岁，采用自体腓骨长肌腱移植。采用Kujala评分评价髌股关节功能，采用Lysholm评分评价膝关节功能，并应用足踝残疾指数(foot and ankle disability index，FADI)对患肢踝关节功能进行评估，同时测量患肢大腿周径的变化，应用膝关节屈膝30°CT平扫或MRI评估髌股关节对合情况。结果两组患者均获得完整随访，随访时间13～28个月，平均(19.2±4.9)个月。两组患者移植物粗细比较，差异无统计学意义(P＞0.05)。腓骨长肌组取腱时间、切口长度更短，差异有统计学意义(P＜0.05)。两组患者末次随访时Kujala评分、Lysholm评分均较术前明显增加(P＜0.05)，同时对应时间点两组间比较差异均无统计学意义(P＞0.05)。末次随访时两组患肢踝关节功能FADI评分比较，差异无统计学意义(P＞0.05)。腓骨长肌组末次随访时大腿周径差值明显小于腘绳肌腱组(P＜0.05)。术后1个月门诊行MRI或屈膝30°CT复查髌股关节，两组髌骨倾斜角(patellar tilt angle，PTA)，髌骨适合角(patellar congruence angle，PCA)数值均减小，同组术前术后变化差异有统计学意义(P＜0.05)，同时对应时间点两组间差异均无统计学意义(P＞0.05)。结论腓骨长肌双束解剖重建内侧髌股韧带末次随访时可达到与腘绳肌腱移植相似的膝关节功能学评分，该方法可获得更小的手术切口，更快的取腱时间，术后患肢大腿肌肉萎缩程度较轻，且对踝关节功能无明显影响。

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	张文豪 1
	牟利民 1*
	魏伟涛 2
	王书华 3
	王国胜 1
	高健 1
	沈志敏 1*

关键词 ：髌股韧带重建, 腓骨长肌, 腘绳肌, 等距重建

Abstract：Objective To compare the clinical outcomes of arthroscopic reconstruction of the medial patellofemoral ligament using double-bundle anatomical reconstruction of the autologous hamstring tendon and the autologous peroneal longus tendon.Methods Data of 55 patients who underwent double-bundle anatomical reconstruction of the medial patellofemoral ligament at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2017 to May 2019 were retrospective analyzed.The patients were divided into two groups according to patient graft distinctions.There were 13 males and 17 females in group A.The patients used autologous hamstring tendon.The mean age was(22.83±10.84) years.There were 11 males and 14 females in group B.The mean age was(21.28±6.95)years.The patients had autologous peroneal longus tendon.The Kujala score was used to assess patellofemoral joint functioning，the Lysholm score was used to assess knee functioning and the foot and ankle disability index (FADI) was used to assess ankle joint functioning in the affected limb.The variation in thigh perimeter of the affected limb was also measured and the patellofemoral joint alignment were assessed by MRI or CT scanat 30°knee flexion.Results All patients in both groups had complete follow-up，which ranged from 13 to 28 months，with a mean of (19.2±4.9) months.There was no statistical difference in the thickness of the grafts between the two groups (P＞0.05).The peroneal longus tendon group had shorter tendon harvesting time and incision length，and the difference was statistically significant (P＜0.05).The Kujala score and Lysholm score at the last follow-up were significantly higher in both groups than before surgery (P＜0.05)，while the differences between the two groups at the corresponding timepoints were not statistically significant (P＞0.05).The difference between the FADI scores of the ankle function in the two groups at the final follow-up was not statistically significant (P＞0.05).The difference in thigh perimeter at the last follow-up was significantly smaller in the peroneus longus group than in the hamstring groucp (P＜0.05).When the patellofemoral joint was reviewed by MRI or CT at 30°of knee flexion at 1 month after surgery，the patellar tilt angle (PTA) and patellar congruence angle (PCA) values decreased in both groups，with statistically significant differences between the preoperative and postoperative changes in the same group (P＜0.05)，while the difference between the two groups was not statistically significant at corresponding timepoints(P＞0.05).Conclusion Reconstruction of the medial patellofemoral ligament by double-bundle anatomical reconstruction of the peroneus longus can achieve functional knee scores similar to those of the hamstring tendon graft at the end follow-up，and this approach results in a smaller surgical incision，faster tendon harvesting time，less postoperative thigh muscle shrinkage in the affected limb，and no significant impact on ankle function.

Key words： patellofemoral ligament reconstruction peroneus longus hamstring isometric reconstruction

基金资助:新疆维吾尔自治区自然科学基金(2019D01C246)

通讯作者: 沈志敏

作者简介: 张文豪(1995－ )，男，研究生在读，新疆医科大学第六附属医院关节二科，898600866@qq.com。

引用本文:

张文豪 1，牟利民 1*，魏伟涛 2，王书华 3，王国胜 1，高健 1，沈志敏 1*. 自体腘绳肌与腓骨长肌双束解剖重建内侧髌股韧带疗效分析[J]. 实用骨科杂志, 2022, 27(2): 120-125.
Zhang Wenhao 1，Mou Limin 1*，Wei Weitao 2，Wang Shuhua 3，Wang Guosheng 1，Gao Jian 1，Shen Zhimin 1*. Analysis of the Outcome of Reconstruction of the Medial Patellofemoral Ligament by Double-bundle Anatomical Reconstruction of the Autogenous Hamstring and Peroneus Longus Tendons. sygkzz, 2022, 27(2): 120-125.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V27/I2/120

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