关节镜下“三联术”治疗复发性髌骨脱位  

Arthroscopically assisted “triple surgery” treatment for recurrent patellar dislocation

作　　者：沈鹏程[1,2] 何耀华[3] 徐能[1,2] 朱立帆[1,2] 翁峰标[1,2] 

机构地区：[1]江苏省苏州市吴江区第一人民医院 [2]南通大学附属吴江医院骨科,江苏吴江215200 [3]上海交通大学附属第六人民医院关节镜骨科,上海200233

出　　处：《生物骨科材料与临床研究》2013年第6期51-53,共3页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的 探讨关节镜辅助下“三联术”治疗复发性髌骨脱位的疗效.方法 2008年4月～2011年9月,应用关节镜辅助下髌股外侧支持带松解、内侧支持带重建、胫骨结节截骨内移抬高术治疗复发性髌骨脱位16例.男4例,女12例;年龄19～43岁,平均22.8岁.初次脱位机制均为外伤,术前平均脱位次数均超过4次.其中左侧7膝,右侧9膝.患者均为向外侧脱位,且脱位后均可手法复位.体格检查恐惧试验阳性,倾斜试验阳性,被动活动受限,膝关节内侧压痛明显.结果 术后切口均Ⅰ期愈合.对16例患者均获得满意随访,随访时间1～2年,平均随访16.7个月.术后3个月内,有3例患者出现髌骨外侧疼痛,5膝出现髌骨内侧紧绷牵拉感,经理疗锻炼后均逐渐消失或好转.随访期间均无髌骨脱位再发生.膝关节术后1年时的Lysholm评分为(95.7±4.2)分,明显高于术前的(63.7±5.3)分,结果有明显的差异性,具有统计学意义(P＜0.05);术后1年Kujala评分为(90.3±2.6)分,也明显高于术前的(61.3±4.3)分,差异有统计学意义(P＜0.05).术后1年患膝功能恢复评分采用Insall标准,其中优13膝,良2膝,可1膝,优良率达93.7％.结论 关节镜辅助下“三联术”治疗复发性髌骨脱位的关节创伤小,恢复佳,早期临床效果满意,值得在临床工作中广泛应用.Objective To evaluate an improving operative procedure and the clinical results of arthroscopically assisted treatment for recurrent patellar dislocation. Methods Between April 2008 and September 2011, 16 patients with recurrent patellar dislocation underwent an improving arthroscopic operation, release of lateral retinaculum, reconstructiong of medical capsule and retinaculum structure and osteotomy of tibial tubercle. There were 4 males and 12 females with an average age of 22.8 years(range 19 to 43 years). All patients had injury history of the first patellar dislocation and experienced parellar dislocation more than 4 times. 7 left knees and 9 right knees were involved. All patients had lateral dislocation and reduction without treatment. The results were positive for apprehension test in all patients with the limitation of passive motion. Lysholm score, Kujala score and Insall scale were adopted to evaluate the effect. Results All incisions healed by first intention. All the patients were followed up 12 to 24 months(16.7 months on average). During the first 3 months after operation, 3 knees suffered pain of soft tissue later to the patella; 5 knees felt tense in the soft tissue medial to the patella, however, all these problems disappeared or recovered gradually after rehabilitation and conservative treatment. No recurrence of dislocation was observed during the follow-up. Lysholm score was significantly improved from preoperative(63.7±5.3) to postoperative(95.7±4.2)( < 0.05). Kujala score was significantly improved from preoperative(61.3±4.3) to postoperative(90.3±2.6)( < 0.05). According to Insall scale, the results were excellent in 13 knees, good in 2 knees, and fair in 1 knees at 1 year after operation with an excellent and good rate of 93.7%. Conclusion The improving procedure of arthroscopically assisted treatment for recrueent patellar dislocation is a minimally invasive operation and has a number of benefits. Its short-term clinical outcome is satisfactory.

关 键 词：复发性髌骨脱位 关节镜 临床效果 重建 

分 类 号：R687.4[医药卫生—骨科学]