內(nèi)側(cè)髕股韌帶撕裂或松弛，可造成髕骨不穩(wěn)，容易向外側(cè)脫位或半脫位。如果脫位反復(fù)發(fā)生，可能需要行內(nèi)側(cè)髕股韌帶重建術(shù)進(jìn)行治療。

警告：請(qǐng)?jiān)谟蠾IFI的場(chǎng)所觀看視頻，土豪請(qǐng)隨意。

MPFL Reconstruction

內(nèi)側(cè)髕股韌帶重建術(shù)

Introduction（介紹）

The kneecap or patella is a triangular-shaped free floating bone that is an important part of the knee joint. The patella rests in a groove on your femur called the trochlea , and glides smoothly in this groove when the knee bends and straightens. The medial patellofemoral ligament or MPFL is a ligament on the inside of the knee that helps to stabilize the patella in the trochlea by preventing it from moving or dislocating outward.

　　膝蓋骨或髕骨是一塊三角形的能自由滑動(dòng)的骨頭，它是膝關(guān)節(jié)重要的組成部分。髕骨棲于股骨遠(yuǎn)端的槽（又稱滑車）上，在膝關(guān)節(jié)伸屈活動(dòng)時(shí)能在滑車上自由滑動(dòng)。內(nèi)側(cè)髕股韌帶簡稱MPFL，是膝關(guān)節(jié)內(nèi)側(cè)維持髕骨在滑車內(nèi)穩(wěn)定的韌帶，防止髕骨向外移動(dòng)或脫位。

Patellar instability is a condition in which the patella slips out of the trochlea, either partially, called subluxation, or fully, called dislocation. The MPFL is usually torn or stretched in the process, making future dislocations more likely.

　　髕骨不穩(wěn)定是髕骨滑出股骨滑車的一種病變，如果部分滑出，稱為半脫位，如果完全滑出，就稱為脫位。這時(shí)，髕股內(nèi)側(cè)韌帶通常會(huì)撕裂或被拉長，今后就更容易發(fā)生脫位。

MPFL reconstruction is a commonly recommended surgical procedure for patients who have experienced repeated patellar dislocations. The surgery involves the reconstruction of the MPFL with the patient’s own tissue or with that of a donor in order to stabilize the knee and allow the patient to return to normal activity.

　　髕股內(nèi)側(cè)韌帶重建術(shù)適用于那些反復(fù)發(fā)生髕骨脫位的病人?？梢杂貌∪俗约旱慕M織或捐獻(xiàn)者的組織進(jìn)行髕股內(nèi)側(cè)韌帶重建，目的是穩(wěn)定膝關(guān)節(jié)，使病人能夠重返正常的活動(dòng)。

Arthroscopy（關(guān)節(jié)鏡）

You will be placed under either general or regional anesthesia. Regional anesthesia numbs the knee and is used with a light sedative so that you will feel as though you are sleeping. In order to determine if you have additional damage inside the joint, your surgeon will perform an arthroscopy during which small incisions are made around the joint and a camera or arthroscope is inserted. Images from the camera are projected to a video monitor, allowing your surgeon to see inside the joint. If you have damage to the cartilage around your patella, it will be removed or repaired using specialized surgical instruments.

　　可以選擇全麻或區(qū)域麻醉。區(qū)域麻醉使膝關(guān)節(jié)麻木，可以配合使用輕型鎮(zhèn)靜藥，這樣術(shù)中病人會(huì)感覺自己睡著了。為明確關(guān)節(jié)內(nèi)是否有其它損傷，外科醫(yī)生會(huì)使用關(guān)節(jié)鏡，通過在關(guān)節(jié)周圍的小切口，插入攝像頭（即關(guān)節(jié)鏡），攝像頭上的圖像會(huì)投射到視頻顯示器，醫(yī)生就可以看到關(guān)節(jié)內(nèi)部的情況。如果髕骨周圍的軟骨有損傷，醫(yī)生會(huì)用特殊的手術(shù)器械將它去除或修復(fù)。

Lateral Retinacular Release（外側(cè)支持帶松解）

Depending upon your specific injury and anatomy, it may be necessary for your surgeon to perform a lateral retinacular release prior to your MPFL reconstruction. The lateral retinaculum is connective tissue on the outside of your patella. In patients with patellar instability, there can be abnormal outward or lateral pull on

the patella that is caused by an overly tight lateral retinaculum. Cutting the tight lateral retinaculum may help to relieve this lateral pressure. Your surgeon will use an arthroscopic probe to split the lateral retinaculum.

　　根據(jù)特定的損傷或解剖情況，醫(yī)生在髕股內(nèi)側(cè)韌帶重建之前，可能需要對(duì)外側(cè)支持帶進(jìn)行松解。外側(cè)支持帶是髕骨外側(cè)的結(jié)締組織。在髕骨不穩(wěn)的病人，可能存在外側(cè)支持帶過緊，異常地將髕骨拉向外側(cè)。切斷緊張的外側(cè)支持帶有助于減輕外側(cè)的拉力。醫(yī)生會(huì)使用關(guān)節(jié)鏡下的探針分離外側(cè)支持帶。

Graft Harvest and Preparation（獲取移植物及準(zhǔn)備）

Next, your own tissue or that of a donor will be used as a graft to reconstruct your MPFL. This animation will demonstrate use of the semitendinosus tendon of your hamstring for the graft. Your surgeon will make a small incision and remove a portion of the semitendinosus tendon. The hamstring graft will be folded over to

increase strength.

　　然后，將使用你自己或捐獻(xiàn)者的組織作為移植物進(jìn)行髕股內(nèi)側(cè)韌帶重建。本動(dòng)畫片中展現(xiàn)的是用自身腘繩肌中的半腱肌的肌腱作為移植物。醫(yī)生用小切口切除一段半腱肌肌腱。將腘繩肌腱移植物折疊以增加力量。

Graft Insertion（插入移植物）

Your surgeon will make a small incision over the medial edge of your patella. Next, two anchors are placed into the patella. The central part of the graft is attached to the anchors. Next, an incision is made over your medial femur and a guide wire is inserted to help accurately drill the femoral hole. A drill is inserted over the guide wire and a new tunnel is created in the femur for the MPFL graft. Finally, the end of the graft is inserted and secured in the femoral tunnel using a bioscrew.

　　醫(yī)生在髕骨內(nèi)緣作一小切口。然后，將兩顆錨釘植入髕骨。移植物的中間部分通過錨釘與髕骨相連。然后，在股骨內(nèi)側(cè)作一切口，插入導(dǎo)針以在股骨上精確地鉆孔。通過導(dǎo)針插入鉆頭，在股骨上為髕股內(nèi)側(cè)韌帶移植物作一個(gè)新的隧道。最后，將移植物的末端插入到股骨隧道內(nèi)，并用生物可吸收螺釘固定。

Recovery and Results（恢復(fù)和結(jié)果）

Typically, MPFL reconstruction is performed in an outpatient center and you should be able to go home the same day. Swelling and discoloration after the procedure are normal and will subside over time. You will be prescribed medication to manage your pain for the first few days and as needed. Your knee will be kept immobilized during walking and standing for six weeks after your surgery, and you will undergo physical therapy in order to help regain full function of your knee. Patients usually return to normal activity after approximately four months. Full recovery, including a return to sports, generally takes from four to six months. MPFL　reconstruction has a high rate of success and patients typically experience great satisfaction with the results of their surgery.

　　通常，髕股內(nèi)側(cè)韌帶重建術(shù)在門診中心完成，術(shù)后當(dāng)天可以回家。術(shù)后腫脹和變色是正常的，隨著時(shí)間推移會(huì)逐漸消失。最初幾天，醫(yī)生會(huì)處方藥物以便你在必要時(shí)控制疼痛。術(shù)后6周內(nèi)，在行走或站立時(shí)膝關(guān)節(jié)應(yīng)制動(dòng)。為了膝關(guān)節(jié)能恢復(fù)良好的功能，可能需要進(jìn)行物理治療。一般，病人在術(shù)后4月左右能夠恢復(fù)正常的活動(dòng)。完全恢復(fù)，包括重返體育運(yùn)動(dòng)，一般需要4~6月。髕股內(nèi)側(cè)韌帶重建術(shù)成功率很高，病人往往對(duì)術(shù)后的結(jié)果感到滿意。

QUESTIONS FOR YOUR DOCTOR

1. What guidelines should I follow prior to my procedure? Will I need other tests or evaluations before the procedure?

　　在手術(shù)之前應(yīng)遵循哪些指南？術(shù)前需要其它檢查和評(píng)估嗎？

2. What will happen if I don’t undergo the procedure now?

　　如果現(xiàn)在不手術(shù)會(huì)有什么影響？

3. Which type of repair will you perform and why is it the appropriate procedure for my condition?

　　您將用哪種修復(fù)方法，為什么這種手術(shù)適合我的情況。

4. How long will the procedure last and will I be under anesthesia?

　　手術(shù)和麻醉需要多久？

5. What kind of graft will be used, and what is the success rate with this material?

　　會(huì)使用哪些移植物？它們的成功率是多少？

6. Will I be given medication after surgery? What tips do you have for me to ease discomfort?

　　術(shù)后需要用藥嗎？緩解不適你有什么好辦法？

7. How long of a recovery period can I expect, and what kind of help will I need during my recovery? Are there special instructions for eating, sleeping, or bathing?

　　術(shù)后恢復(fù)需要多久？恢復(fù)期間需要什么樣的輔助治療？吃飯、睡覺、洗浴等有什么特殊講究嗎？

8. When can I bear full weight on the surgical side after the procedure?

　　術(shù)后多久手術(shù)側(cè)可以完全負(fù)重？

9. When can I return to work, resume normal activity, drive, and exercise?

　　我什么時(shí)候可以上班、恢復(fù)正常的活動(dòng)、開車及鍛煉？

10. Will I need physical therapy?

　　需要物理治療嗎？

（胡佰文   譯）

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