内侧髌股韧带重建术中骨骺闭合与否对股骨侧定位方法选择的影响

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摘要目的探讨在内侧髌股韧带重建手术过程中骨骺闭合与否对股骨侧定位方法选择的影响。方法选取2018年9月至2022年5月安徽医科大学第一附属医院运动创伤与关节镜外科收治的复发性髌骨脱位患者共88例，骨骺未闭合组48例，其中男性20例，女性28例；年龄12~15岁，平均(12.72±1.62)岁。骨骺闭合患者40例，男性14例，女性26例；年龄16~24岁，平均(19.25±1.58)岁。行患侧膝关节三维CT及X线检查，并分别于三维CT影像上标记出Schottle点为S点；内收肌结节与股骨内侧髁中点为A点；Fujino定位点为F点。分别测量SA、SF之间的距离。随机采用内收肌结节辅助定位法及中心定位法两种定位方法进行术中定位，最后通过比较青少年患者末次随访的Kujala评分、Lysholm评分等方法评价上述两种定位法在治疗青少年髌骨脱位中的临床疗效。结果相较于骨骺闭合的患者，临床上常用的解剖学定位方法：中点定位法，确定的股骨侧定位点(A点)与S点之间距离差异有统计学意义(P＜0.05)，而以内收肌结节辅助定位法为代表的解剖学定位法，其运用于骨骺未闭合患者中的“等长性”效果更佳，同时其术后随访的临床疗效显著优于前者。结论相较于成人MPFL重建手术中股骨侧的定位方法，中点定位法在骨骺未闭合的患者中并非最优选择，而内收肌结节辅助定位法更加适用于儿童或骨骺未闭合的青少年。

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	贾熠辰
	徐斌
	郭瑞鹏

关键词 ：股骨远端骨骺, 青少年, 髌骨脱位, 内侧髌股韧带重建, 股骨等距点

Abstract：Objective To investigate the influence of epiphyseal closure on the choice of lateral femoral positioning method during medial patellofemoral ligament reconstruction surgery.Methods A total of 88 patients with recurrent patellar dislocation admitted to the Department of Sports Trauma and Arthroscopy in the First Affiliated Hospital of Anhui Medical University from September 2018 to May 2022 were selected.There were 48 cases in the epiphysis unclosed group，including 20 males and 28 females.The patients aged 12~15 years，with an average of (12.72±1.62) years.There were 40 patients with closed epiphysis，including 14 males and 26 females.The patients age ranged from 16 to 24 years，with an average age of (19.25±1.58) years.The point of Schottle was marked as point S and the midpoint of the medial tuberosity and medial femoral condyle was marked as point A.The point of Fujino's position was marked as point F.The distance between SA and SF was measured separately.The clinical efficacy of these two positioning methods in the treatment of patellar dislocation in adolescents was evaluated by comparing the Kujala score and Lysholm score at the last followup of adolescent patients.Results Compared to patients with closed epiphyses，there was a significant difference (p < 0.05) in the distance between the lateral femoral positioning point (point A) and point S determined by the anatomical positioning method commonly used in clinical practice：The midpoint positioning method，and the anatomical positioning method represented by the medial tuberosityassisted positioning method，which was used in patients with unclosed epiphyses for “isometric”.The anatomical localization method，represented by the nodal-assisted localization method，was more effective in patients with unclosed epiphyses.It also has a significantly better clinical outcome at post-operative patient follow-up than the former.Conclusion Compared to the lateral femoral positioning method in adult MPFL reconstruction，the midpoint positioning method is not optimal in patients with unclosed epiphyses，while the adductor node assisted positioning method is more suitable for children or adolescents with unclosed epiphyses.

Key words： distal femoral epiphysis adolescent patellar dislocation medial patellofemoral ligament reconstruction femoral isometrical point

通讯作者: 徐斌

作者简介: 贾熠辰(1997－ )，男，研究生在读，安徽医科大学第一附属医院运动创伤与关节镜外科，757110725@qq.com

引用本文:

贾熠辰，徐斌，郭瑞鹏. 内侧髌股韧带重建术中骨骺闭合与否对股骨侧定位方法选择的影响[J]. 实用骨科杂志, 2023, 29(4): 315-.
Jia Yichen，Xu Bin，Guo Ruipeng. Influence of Epiphyseal Closure on the Choice of Lateral Femoral Positioning Method During Medial Patellofemoral Ligament Reconstruction. sygkzz, 2023, 29(4): 315-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I4/315

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