骨科手术早知道122：内侧髌股韧带重建术（MPFL Reconstruction）
内侧髌股韧带撕裂或松弛，可造成髌骨不稳，容易向外侧脱位或半脱位。如果脱位反复发生，可能需要行内侧髌股韧带重建术进行治疗。
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MPFL Reconstruction
内侧髌股韧带重建术
Introduction（介绍）
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.
膝盖骨或髌骨是一块三角形的能自由滑动的骨头，它是膝关节重要的组成部分。髌骨栖于股骨远端的槽（又称滑车）上，在膝关节伸屈活动时能在滑车上自由滑动。内侧髌股韧带简称MPFL，是膝关节内侧维持髌骨在滑车内稳定的韧带，防止髌骨向外移动或脱位。
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.
髌骨不稳定是髌骨滑出股骨滑车的一种病变，如果部分滑出，称为半脱位，如果完全滑出，就称为脱位。这时，髌股内侧韧带通常会撕裂或被拉长，今后就更容易发生脱位。
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.
髌股内侧韧带重建术适用于那些反复发生髌骨脱位的病人。可以用病人自己的组织或捐献者的组织进行髌股内侧韧带重建，目的是稳定膝关节，使病人能够重返正常的活动。
Arthroscopy（关节镜）
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.
可以选择全麻或区域麻醉。区域麻醉使膝关节麻木，可以配合使用轻型镇静药，这样术中病人会感觉自己睡着了。为明确关节内是否有其它损伤，外科医生会使用关节镜，通过在关节周围的小切口，插入摄像头（即关节镜），摄像头上的图像会投射到视频显示器，医生就可以看到关节内部的情况。如果髌骨周围的软骨有损伤，医生会用特殊的手术器械将它去除或修复。
Lateral Retinacular Release（外侧支持带松解）
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.
根据特定的损伤或解剖情况，医生在髌股内侧韧带重建之前，可能需要对外侧支持带进行松解。外侧支持带是髌骨外侧的结缔组织。在髌骨不稳的病人，可能存在外侧支持带过紧，异常地将髌骨拉向外侧。切断紧张的外侧支持带有助于减轻外侧的拉力。医生会使用关节镜下的探针分离外侧支持带。
Graft Harvest and Preparation（获取移植物及准备）
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，将使用你自己或捐献者的组织作为移植物进行髌股内侧韧带重建。本动画片中展现的是用自身腘绳肌中的半腱肌的肌腱作为移植物。医生用小切口切除一段半腱肌肌腱。将腘绳肌腱移植物折叠以增加力量。
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.
医生在髌骨内缘作一小切口。然后，将两颗锚钉植入髌骨。移植物的中间部分通过锚钉与髌骨相连。然后，在股骨内侧作一切口，插入导针以在股骨上精确地钻孔。通过导针插入钻头，在股骨上为髌股内侧韧带移植物作一个新的隧道。最后，将移植物的末端插入到股骨隧道内，并用生物可吸收螺钉固定。
Recovery and Results（恢复和结果）
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，髌股内侧韧带重建术在门诊中心完成，术后当天可以回家。术后肿胀和变色是正常的，随着时间推移会逐渐消失。最初几天，医生会处方药物以便你在必要时控制疼痛。术后6周内，在行走或站立时膝关节应制动。为了膝关节能恢复良好的功能，可能需要进行物理治疗。一般，病人在术后4月左右能够恢复正常的活动。完全恢复，包括重返体育运动，一般需要4~6月。髌股内侧韧带重建术成功率很高，病人往往对术后的结果感到满意。
QUESTIONS FOR YOUR DOCTOR
1. What guidelines should I follow prior to my procedure? Will I need other tests or evaluations before the procedure?
在手术之前应遵循哪些指南？术前需要其它检查和评估吗？
2. What will happen if I don’t undergo the procedure now?
如果现在不手术会有什么影响？
3. Which type of repair will you perform and why is it the appropriate procedure for my condition?
您将用哪种修复方法，为什么这种手术适合我的情况。
4. How long will the procedure last and will I be under anesthesia?
手术和麻醉需要多久？
5. What kind of graft will be used, and what is the success rate with this material?
会使用哪些移植物？它们的成功率是多少？
6. Will I be given medication after surgery? What tips do you have for me to ease discomfort?
术后需要用药吗？缓解不适你有什么好办法？
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?
术后恢复需要多久？恢复期间需要什么样的辅助治疗？吃饭、睡觉、洗浴等有什么特殊讲究吗？
8. When can I bear full weight on the surgical side after the procedure?
术后多久手术侧可以完全负重？
9. When can I return to work, resume normal activity, drive, and exercise?
我什么时候可以上班、恢复正常的活动、开车及锻炼？
10. Will I need physical therapy?
需要物理治疗吗？
（胡佰文 译）