关节镜下髌骨支持带调整术联合Fulkerson截骨治疗复发性髌骨脱位  

Treatment of recurrent patella dislocation through arthroscopic patellar retinaculum adjustment and Fulkerson osteotomy

作　　者：赵金忠[1] 何耀华[1] 王建华[1] 

机构地区：[1]上海交通大学附属第六人民医院关节镜外科,200233

出　　处：《中华骨科杂志》2005年第6期326-331,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨联合应用关节镜下髌骨支持带调整术和Fulkerson截骨术治疗复发性髌骨脱位的效果。方法对35例复发性髌骨脱位的患者,在关节镜下进行髌骨支持带调整术,包括内侧支持带紧缩术和外侧支持带松解术,同时进行Fulkerson胫骨结节内移抬高术。术前脱位次数3～16次,平均6次;初次脱位机制均为外伤。术后通过平均25个月(13～37个月)的随访,了解膝关节脱位复发、患膝主观症状以及患肢整体功能康复情况。结果最后随访时,髌骨脱位无复发。8例仍有膝关节前侧疼痛,但疼痛均较术前有所减轻。手术前后IKDC膝关节功能主观评分分别为(37.4±4.9)分和(92.1±5.3)分(P<0.01),Lysholm膝关节功能评分分别为(43.0±6.3)分和(93.2±6.1)分(P<0.01)。所有患者运动能力均较术前有所改善。初次脱位前和术后Tegner运动水平评分分别为(6.9±1.1)分和(7.0±0.9)分。术后X线检查对比发现,髌骨-股骨滑车适配角从术前的27.7°±7.9°改善为1.4°±8.1°(P<0.01),髌骨外侧面张开角从术前的-1.1°±7.4°改善为术后的11.8°±4.9°(P<0.01)。结论关节镜下进行髌骨内侧支持带紧缩和外侧支持带松解,创伤小;结合Fulkerson胫骨结节内移抬高术能够有效治疗复发性髌骨脱位,防止复发,并有利于缓解症状,恢复膝关节功能。Objective To introduce the way of arthroscopic patellar retinaculum adjustment and Fulkerson osteotomy, and to study its clinical results. Methods 35 cases of recurrent patella dislocation were treated by modified Fulkerson tibial tubercle anteromedial transfer, and arthroscopic patellar retinaculum adjustment including the medial retinaculum plication and lateral retinaculum releasing. The tibial tubercle was transferred 1.5 cm anteriorly and medially, and fixed with three Kirschner wires. The patients were followed for 25 months in average. The rate of reccurence, the subjective symptoms and the function of the injured leg were evaluated according to the IKDC and Lysholm rating scale. X-ray examination was taken to evaluate the patella-femur congruence. Results There were no recurrence at the last follow-up. Anterior knee pain, though in slight degree, still existed in 8 cases. The IKDC subjective knee scores were 37.4±4.9 and 92.1±5.3(P< 0.01), and the Lysholm knee score were 43.0±6.3 and 93.2±6.1(P< 0.01) before and after surgery respectively. The sport ability improved in all cases. The Tegner sport level was 6.9±1.1 and 7.0±0.9 respectively before the first dislocation and after surgery. X-ray examination showed that the patella-femur congruence angle improved from 27.7°±7.9° to 1.4°±8.1°(P< 0.01), and the lateral patella angle from -1.1°±7.4° to 11.8°±4.9°(P< 0.01) in average. Conclusion It is effective to treat recurrent patella dislocation by way of arthroscopic patellar retinaculum adjustment and Fulkerson osteotomy, the operation is aimed to prevent recurrence, alleviate symptoms, and restore knee function to the greatest extent.

关 键 词：复发性髌骨脱位 关节镜下 调整术 截骨治疗 Fulkerson截骨术 外侧支持带松解术 膝关节功能 胫骨结节 膝关节脱位 同时进行 功能康复 主观症状 手术前后 功能评分 运动能力 有效治疗 防止复发 术后 紧缩术 前脱位 无复发 

分 类 号：R687[医药卫生—骨科学]