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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (5): 947-955. doi: 10.19723/j.issn.1671-167X.2025.05.020

• 论著 • 上一篇    下一篇

镜下内侧髌股复合体重建治疗伴高级别滑车发育不良复发性髌骨脱位的临床疗效

胡枫艺, 孟庆阳, 陈拿云, 王佳宁, 刘振龙, 马勇, 杨渝平, 龚熹, 王成, 刘平*(), 史尉利*()   

  1. 北京大学第三医院运动医学科, 北京大学运动医学研究所, 运动医学关节伤病北京市重点实验室, 北京 100191
  • 收稿日期:2023-02-06 出版日期:2025-10-18 发布日期:2024-05-07
  • 通讯作者: 刘平, 史尉利
  • 基金资助:
    北京大学第三医院临床重点项目(BYSYZD2022011); 北京市科学技术委员会科技新星交叉学科合作课题(Z211100002121015)

Clinical efficacy of arthroscopic medial patellofemoral complex reconstruction for recurrent patellar dislocation with high-grade trochlear dysplasia

Fengyi HU, Qingyang MENG, Nayun CHEN, Jianing WANG, Zhenlong LIU, Yong MA, Yuping YANG, Xi GONG, Cheng WANG, Ping LIU*(), Weili SHI*()   

  1. Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2023-02-06 Online:2025-10-18 Published:2024-05-07
  • Contact: Ping LIU, Weili SHI
  • Supported by:
    Peking University Third Hospital Clinical Key Program(BYSYZD2022011); Interdisciplinary Cooperation Project of Beijing Nova Program of Beijing Municipal Science & Technology Commission(Z211100002121015)

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摘要： 目的: 探究关节镜下内侧髌股复合体(medial patellofemoral complex, MPFC)重建治疗伴高级别股骨滑车发育不良复发性髌骨脱位的中期临床疗效。方法: 回顾2014年1月至2020年12月间接受关节镜下MPFC重建的复发性髌骨脱位成人患者的临床资料, 评估Dejour分型以衡量滑车发育不良程度, 测量胫骨结节-股骨滑车沟(tibial tubercle-trochlear groove, TT-TG)间距与Insall-Salvati指数。比较术前和术后国际膝关节文献委员会(International Knee Documentation Committee, IKDC)、Kujala、Lysholm和Tegner评分, 评估运动恢复情况、复发与并发症。基于轴位电子计算机断层扫描影像, 测量术前和术后影像学参数髌骨倾斜角、髌骨外移距离和等分偏移率(bisect offset ratio, BSO)比值, 评估髌股关节对位关系恢复情况。结果: 共纳入43例患者(46膝), 其中男性16例, 女性27例。手术时患者平均年龄为(22.2±7.6)岁(范围为14~44岁), 平均随访(49.9±22.6)个月(范围为18~102个月)。Dejour B、C、D型分别占37.0%(17/46)、43.5%(20/46)和19.6%(9/46), 平均Insall-Salvati指数1.2±0.2(范围为0.85~1.44), 平均TT-TG间距(19.6±3.5) mm(范围为10.6~28.7 mm)。末次随访时, 各膝关节功能评分较术前均有显著提高(P < 0.001): IKDC评分由56.3±15.1至86.2±8.1, Kujala评分由58.9±15.6至92.6±5.4, Lysholm评分由63.7±15.0至94.0±5.7, Tegner评分由3.1±1.4至4.7±1.4, 改善量在Dejour各型之间差异无统计学意义, 总体运动恢复率达90%。1例患者出现术后髌骨半脱位, 所有患者均未报告关节感染、活动受限或髌骨骨折。术后髌骨倾斜角、髌骨外移距离和BSO比值较术前均有明显改善(P < 0.001)。结论: 关节镜下MPFC重建治疗伴高级别滑车发育不良复发性髌骨脱位的中期临床疗效满意, 高级别滑车发育不良各分型之间膝关节功能改善差异无统计学意义。

关键词: 髌骨脱位, 复发, 内侧髌股复合体重建, 股骨滑车发育不良, Dejour分型

Abstract: Objective: To investigate the midterm clinical efficacy of medial patellofemoral complex (MPFC) reconstruction for recurrent patellar dislocation with high-grade trochlear dysplasia. Methods: A retrospective analysis was carried out among adult patients who underwent arthroscopically assisted MPFC reconstruction between January 2014 and December 2020. Dejour classification was evaluated to grade trochlear dysplasia; tibial tubercle-trochlear groove (TT-TG) distance and Insall-Salvati index were measured. Preoperative and postoperative patient-reported outcome measures (PROMs) were compared, including International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score and Tegner score. Information regarding returning-to-sport rate, re-instability events and complications was collected. Patellar tilt (PT), lateral patellar displacement (LPD) and bisect offset (BSO) ratio were measured based on axial computed tomography before and after surgery to assess the patellofemoral congruence. Results: A total of 46 MPFC reconstructions in 43 patients were enrolled, including 16 male and 27 female. Mean age at surgery was (22.2±7.6) years (range: 14-44 years). Mean follow-up was (49.9±22.6) months (range: 18-102 months). The percentages of Dejour B, C and D dysplasia were 37.0% (17/46), 43.5% (20/46), and 19.6% (9/46), respectively. Mean Insall-Salvati index was 1.2±0.2 (range: 0.85-1.44), and mean TT-TG distance was (19.6±3.5) mm (range: 10.6-28.7 mm). At latest follow-up, there were significant improvements in all PROMs (P < 0.001): IKDC score, from 56.3±15.1 to 86.2±8.1; Kujala score, from 58.9±15.6 to 92.6±5.4; Lysholm score, from 63.7±15.0 to 94.0±5.7; Tegner score, from 3.1±1.4 to 4.7±1.4, and there were no significant differences in the improvements of the scores between the patients with Dejour B, C and D dysplasia. Overall, ninety percent of the patients returned to their preoperative sports level. One patient reported a postoperative subluxation, while no cases of infection, limited range of motion or patella fracture were observed. PT, LPD and BSO ratio were all significant altered (P < 0.001) after MPFC reconstruction. Conclusion: Arthroscopically assisted MPFC reconstruction yielded satisfactory midterm clinical results for recurrent patellar dislocation with high-grade trochlear dysplasia. No significant differences of improvements in knee function were observed among the three types of high-grade trochlear dysplasia.

Key words: Patellar dislocation, Recurrence, Medial patellofemoral complex reconstruction, Femoral trochlear dysplasia, Dejour classification

中图分类号: 

  • R684.76

图1

关节镜下内侧髌股复合体重建"

图2

基于轴位CT的Dejour分型示例"

图3

侧位X线及轴位CT影像学指标的测量方法"

表1

解剖学危险因素及软骨损伤"

Parameters Data
Dejour classification
  Type B 17 (37.0)
  Type C 20 (43.5)
  Type D 9 (19.6)
Patellar height (Insall-Salvati index) 1.2±0.2
   < 1.2 21 (45.7)
  ≥ 1.2 25 (54.3)
TT-TG distance 19.6±3.5
   < 20 mm 24 (52.2)
  ≥ 20 mm 22 (47.8)
Patellar tilt/(°) 30.9±10.5
Chondral lesion
  Patella > ICRS Ⅱ 23 (50.0)
  Trochlea > ICRS Ⅱ 1 (2.2)
  Lateral femoral condyle > ICRS Ⅱ 8 (17.3)

表2

Dejour B~D型间解剖学危险因素的比较"

Parameters Type B (n=17) Type C (n=20) Type D (n=9) F P
Insall-Salvati index 1.1±0.2 1.2±0.2 1.3±0.1 2.641 0.083
TT-TG distance/mm 19.0±3.3 19.4±3.9 21.2±2.5 1.232 0.302
Patellar tilt/(°) 30.2±9.1 31.2±12.7 31.9±8.7 0.066 0.936

表3

术前及术后膝关节功能评分对比"

Outcome measures Preoperative score Postoperative score Z P
IKDC score 56.3±15.1 86.2±8.1 -5.896 < 0.001
Kujala score 58.9±15.6 92.6±5.4 -5.906 < 0.001
Lysholm score 63.7±15.0 94.0±5.7 -5.906 < 0.001
Tegner score 3.1±1.4 4.7±1.4 -4.867 < 0.001
Subjective satisfaction 9.1±1.0

表4

Dejour B~D型间膝关节功能评分改善量比较"

Outcome measures Type B (n=17) Type C (n=20) Type D (n=9) F P
ΔIKDC score 27.2±17.7 29.1±15.2 37.0±13.7 1.173 0.319
ΔKujala score 27.5±12.8 30.8±13.9 34.4±13.5 1.378 0.263
ΔLysholm score 31.6±14.8 32.1±14.9 41.0±14.6 0.815 0.449
ΔTegner score 1.4±1.5 1.5±1.7 2.2±1.4 0.896 0.416

表5

术后膝关节疼痛与软骨损伤程度相关性分析"

Chondral lesion No lesion ICRS Ⅰ ICRS Ⅱ ICRS Ⅲ ICRS Ⅳ P
Patella 0.869
  Symptomatic knee pain (-) 3 2 13 9 8
  Symptomatic knee pain (+) 2 0 3 3 3
Trochlea facet 0.287
  Symptomatic knee pain (-) 12 2 21 0 0
  Symptomatic knee pain (+) 5 0 5 1 0
Lateral femoral condyle >0.995
  Symptomatic knee pain (-) 26 1 1 2 5
  Symptomatic knee pain (+) 10 0 0 0 1

表6

术前及术后髌股关节CT参数对比"

Parameters Preoperative value Postoperative value Z P
Patellar tilt/(°) 30.9±10.5 9.8±6.0 -5.443 < 0.001
Lateral patellar displacement/mm 10.4±8.1 -8.7±7.1 -5.442 < 0.001
Bisect offset ratio 1.1±0.3 0.6±0.2 -5.442 < 0.001

图4

内侧髌股复合体重建前后髌股关节轴位CT对比"

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ISSN 1671-167X
CN 11-4691/R
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