재발성 슬개골 불안정성에서 자가 슬괵건을사용한 내측 슬개대퇴 인대 재건술-예비 보고-
Medial Patellofemoral Ligament Reconstruction Using the Autogenous Hamstring Tendon for Recurrent Patellar Instability -A Preliminary Report-
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목적: 슬개골의 재발성 불안정성 환자 치료에서 자가 슬괵건을 사용한 내측 슬개대퇴 인대 재건술 후 결과를 알아보고자 하였다. 대상 및 방법: 2008년 2월부터 2008년 11월까지 슬개골의 재발성 불안정성으로 진단받고 자가 슬괵건을 사용하여 내측 슬개대퇴 인대 재건술을 시행한 7명, 7예를 대상으로 하였고 평균 추시 기간은 13.6개월(12∼15개월)이었다. 수술 전후에 이학적 검사로 불안감 검사, patellar grind test, Q-각을, 임상적 평가로 Kujala 점수, Lysholm 점수, Tegner 점수를 조사하였다. 방사선학적으로 일치각과 변형 Insall-Salvati 방법에 의해 슬개골의 이상 고위 여부를 측정하였고 대퇴 활차의 이형성 및 슬개골 이형성 여부를 알아보았다. 결과: 이학적 검사에서 불안감 검사는 술 전 전례에서 양성, 최종 추시시 전례에서 음성 소견을 보였고, patellar grind test는 술 전 전례에서 양성, 최종 추시 시 1예에서 양성 소견을 보였다. Q-각은 술 전 평균 16.9°에서 최종 추시 시 18.3o로 측정되었다. Kujala 점수는 술 전 평균 33.7점에서 최종 추시 시 94.1점으로(p=0.018), Lysholm 점수는 술 전 평균 42.4점에서 최종 추시 시 92.6점으로(p=0.018), Tegner 점수는 술 전 평균 2.1에서 최종 추시 시 5.1로(p=0.026) 향상되었다. 변형 Insall-Salvati 지수는 술 전 평균 1.97 (1.37∼2.53)에서 최종 추시 시 1.6 (1.27∼2.14)(p=0.028), 일치각은 술 전 평균 10.2o (−10.8∼42.5o)에서 최종 추시 시 −3.4o (−11.8∼8.1o)로(p=0.018) 측정되었다. 결론: 단기 추시 결과 슬개골의 재발성 불안정성 환자 치료에서 자가 슬괵건을 사용한 내측 슬개대퇴 인대 재건술을 시행하여 슬개골에 안정성 유지에 좋은 결과를 보였다.
Abstract
Purpose: We present the short-term results of medial patellofemoral ligament (MPFL) reconstruction using the autogenous hamstring tendon for recurrent patellar instability. Materials and Methods: Seven patients with recurrent patellar instability were treated with MPFL reconstruction using a semitendinosus or gracilis autograft from February 2008 to November 2008. All the patients were evaluated preoperatively and postoperatively according to the physical findings, scores and radiographs, with a mean follow-up of 13.6 months (range: 12∼15 months). Results: The apprehension test was positive in all the knees preoperatively and no knee was found to be positive at the follow-up. The grind test was positive in all the knees preoperatively and one knee was found to be positive at the follow-up. The Q-angle was 16.9o preoperatively and 18.3o at the follow-up. The Kujala score improved from 33.7 points to 94.1 points (p=0.018), the Lysholm score improved from 42.4 points to 92.6 points (p=0.018) and the Tegner activity level improved 2.1 to 5.1 (p=0.026). The congruence angle was 10.2o preoperatively and −3.4o at follow-up (p=0.018). The patellar height was 1.95 preoperatively and 1.6 at follow-up (p=0.028). There were no patients with recurrent dislocation. Conclusion: MPFL reconstruction using the autogenous hamstring tendon for recurrent patellar instability is an effective operation, according to the short term follow-up.
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