膝关节镜动态监视下分级手术治疗髌股关节紊乱  

Treatment of patellofemoral joint disorders with graded surgery under knee arthroscopic monitoring

作　　者：郭林[1] 杨柳[1] 戴刚[1] 陈光兴[1] 段小军[1] 代伟[1] 古凌川[1] 王凤铃[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《中华关节外科杂志（电子版）》2007年第5期309-311,共3页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨膝关节镜在髌股关节紊乱诊断与动态监测下实施三级髌股序列重排术式的早中期疗效。方法2002年1月至2004年12月第三军医大学西南医院关节外科中心收治了87例(99膝)年龄在12～33岁(平均17.2岁)之间的膝关节髌股关节紊乱的患者,均采用膝关节镜进行诊疗,三级髌股序列重排术式分别为:1.外侧支持带滑膜外松解术;2.术式1+内侧支持带紧缩缝合术;3.术式2+胫骨结节止点内下移位术。在关节镜动态监测下对不同程度的髌股关节紊乱进行治疗。以0°～110°屈膝过程中髌股关节适配良好为术中平衡满意的标准。随访时利用Lysholm问卷随访调查,同时对其临床资料进行回顾性分析。结果87例(103膝)患者中行术式1的患者53例(61膝),行术式2的患者20例(24膝),行术式3的患者14例(23膝)。64例(79膝)患者在术前即诊断为髌股关节紊乱。其中行术式2和3的患者全部在术前诊断明确。随访36～71个月(平均54.2月),Lysholm评分89～100分,平均96.3分。无1例患者髌骨脱位复发,7例(9膝)患者残存不同程度术后膝前疼痛,年龄22～29岁(平均26.3岁),均伴有髌股关节软骨损伤。结论关节镜动态监视下对髌骨序列排列异常的诊断和分级更具有实用治疗价值,依据动态监视结果选择性实施三级髌股序列重排术在术中均精确平衡髌股关节适配性并达到满意,术后随访中发现总体随访效果较好。患者年龄偏大且合并髌股关节软骨损伤是术后疗效不佳的原因之一,提示这可能是外科介入的禁忌之一。Objective To investigate the clinical results of three-grade surgery of three-grade realignment surgery in patellofemoral joint under real time knee arthroscopic monitoring. Methods 87 pa- tients （99 knees） aged 12 to 33 （ mean 17.2 ） with patellofemoral disorders were treated with knee arthroscopy from January 2002 to December 2004. Three grades realignment operations of patellofemoral joint ineludes： 1. Release of lateral reticulum; 2. Operation mode 1 plus medial reticulum augmentation suturing; 3. Operation mode 2 plus inferomedial translation of tibial tubercle. All cases were treated under arthroscopic monitoring. Patella and femoral trochlear groove should match during 0-120 degree knee flexion after realignment. Patients were followed-up with Lysholm score and clinical data were analyzed at the same time. Results Out of 87 cases （103 knees） , 53 patients （61 knees） took operation mode 1, 20 patients （24 knees） took operation mode 2 and 14 patients （23 knees） took operation mode 3. 64 cases （79 knees） were diagnosed as patellofemoral disorder before surgery. Patients were followed-up for 36-71 months （mean 54.2 months）. Lysholm score was 89-100 （ mean 96.3 ）. No relapse of dislocation was found at the time of follow-up. 7 cases （ 9 knees ） aged 22-29 years （ mean 26.3 years） have anterior knee pain after surgery. Clinical data showed damage of patellofemoral cartilage at the time of surgery. Conclusion Diagnosis and realign-ment operation under the direct monitoring of arthroscopy are important principles for treatment of patellofemoral disorder. Three-grade realignment operation can achieve precise matching of patellofemoral joint under arthroscopic monitoring. Postoperative follow-up result is good to excellent to most patients. Patients at elder age and with patellofemoral chondral lesion could have poor medium term result, and this may indicate that elder age combined with chondral lesion is one of the contraindications for surgical intervene.

关 键 词：膝 关节镜 关节疾病 截骨术 

分 类 号：R687.4[医药卫生—骨科学]