髌股内侧韧带重建.pptVIP

Medial patellofemoral ligament reconstruction with a divergent patellar transverse 2-tunnel technique髌骨双隧道技术重建内侧髌股韧带 Panni AS,Alam M, Cerciello S,et al.Am J Sports Med,2011,39(12):2647-2655. history review 复发性髌骨脱位临床上常见，严重影响患者运动功能和日常生活。既往治疗方法很多，包括近端力线重排、胫骨结节内移、股骨滑车成形、髌骨切除等。近年来随着对内侧髌股韧带（medial patellofemoral ligament，MPFL）研究的深入，MPFL 重建为复发性髌骨脱位提供了新的治疗方法。 anatomy of MPFL 浅层较薄 筋膜组成 深层 ：内侧髌股韧带（100%）、内侧髌胫韧带（100%）和内侧髌半月板韧带（80%）三个独立结构，MPFL是将髌骨固定于股骨的主要结构，对限制髌骨外移起决定性作用。 anatomy of MPFL MPFL起自股骨的内收肌结节向前呈扇形发散止于髌骨内侧端，髌骨端附着点较宽，多数学者认为其在髌骨端可以分为两束，上束相当于在髌骨内上角，下束在髌骨内缘中点 。 anatomy of MPFL Steensen等在解剖研究中发现MPFL在髌骨上缘止点的位置相当于在髌骨内上角，到髌骨上极的平均垂直距离为6.1 mm，下缘止点在髌骨内缘的中点，到髌骨上极的平均垂直距离为23.1 mm，MPFL髌骨止点的平均宽度为17mm， Function of MPFL 解剖及生物力学研究证实MPFL是限制髌骨外移脱位、保持良好髌骨轨迹最重要的静力性稳定结构。 ——占内侧总限制力的53％～60％ 国外学者报道急性髌骨脱位中94%会出现MPFL撕裂。 . New idea MPFL重建为复发性髌骨脱位提供了新的治疗方法。 目的：恢复髌骨内侧的稳定结构 限制髌骨向外侧脱位 Study design Forty-eight patients (51 knees) with at least 3 episodes of lateral patellar dislocation who had been treated with a 6-month rehabilitation protocol were included in this study. Methods of reconstruction Reconstruction was with a semitendinosus tendon using a divergent 2-tunnel technique. Outcome was evaluated with the Kujala, modified Lysholm, and Fulkerson outcome scores. Methods of reconstruction Methods of reconstruction Postoperative rehabilitation began with continuous passive motion from 0° to 90°with mobilization in a hinged brace. the first 3 weeks : partial weightbearing 3 weeks’follow-up: the brace was removed and full weightbearing allowed After 8 weeks: gentle jogging on the-spot on a trampoline was commenced 12 weeks : full return to sports, including contact sports, planned at the 6-month stage. Results Three patients were lost at the final follow-up, giving a follow-