改良三联术治疗髌股关节不稳定的疗效分析  

Modified Triple Surgery for Patellofemoral Instability

作　　者：王鹏[1] 纪斌平[1] 

机构地区：[1]山西医科大学第二医院骨科,山西太原030001

出　　处：《中国现代医生》2009年第36期37-38,44,共3页China Modern Doctor

摘　　要：目的探讨髌骨外侧支持带松解内侧支持带紧缩联合胫骨结节旋转内移术(改良三联术)治疗髌股关节不稳定症的临床疗效。方法对30例(40膝)髌股关节不稳定症患者行髌骨外侧支持带松解内侧支持带紧缩联合胫骨结节旋转内移术。术后平均随访25.60个月(6～62个月)。手术前后测量Q角,采用Kujala评分表和膝关节日常活动评分表比较髌股关节功能恢复情况。并通过屈膝30°的CT检查测量并比较患者手术前后髌股关节对合情况的参数指标。结果Q角术前(23.78±3.76)°,术后(13.78±3.52)°(P<0.01);Kujala评分术前54.08±15.72,术后80.33±9.74(P<0.01);膝关节日常活动评分术前54.98±14.96,术后80.20±9.53(P<0.01);手术前后CT检查结果比较:适合角(CA)、外侧髌骨角(LPA)、髌骨外移率(LS)、髌骨指数(PE)、倾斜角(TA)、髌骨倾斜角(PTA)、股骨滑车凹中心与胫骨结节的距离(TTTD)7项指标的差异也均有统计学意义(P<0.01)。结论本手术可以纠正髌骨病理运动轨迹,改善髌股关节功能,缓解髌股疼痛,并发症少,矫形可靠,是治疗髌股关节不稳定症的有效方法。Objective To investigate the modified triple surgery （lateral patellofemoral ligament releasing and medial patellofemoral ligament reefing with tibial tubercle revolving-anteromedia displacement） to treat patellofemoral instability. Methods Thirty patients （40 knees） who were comfirmed to be patellofemoral instability underwent the modified triple surgery. The patients were followed up and the mean follow-up period was 25.60 months. Before and after the modified triple surgery,the Q angle was measured and Patellofemoral joint function recovery was assessed by using the Kujala patellofemoral score and knee joint daily activity score. The CT examination of the patellofemoral joint was carried out by knee flexion 30° ,and the comparison of the related indexes of the patellofemoral alignment was made including： CA, LPA,LS,PE,TA,PTA and TTTD. Results The Q angle was（23.78 ± 3.76）° preoperatively and（ 13.78 ± 3.52）° postoperatively; the Kujala score was（54.08 ± 15.72）preoperatively and（80.33 ± 9.74）postoperatively; the knee joint daily activity score was（54.98 ± 14.96）preoperatively and（80.20 ± 9.53）postoperatively. There were significant differences between preoperation and postoperation（P〈0.01 ）. Conclusion The modified triple surgery can thoroughly rectify the maltracking of patellofemoral joint, relieve patellofemoral pain and improve patellofemoral joint functions. This technique is an effective surgery for patellofemoral instability.

关 键 词：髌股关节不稳定症 胫骨结节 手术治疗 

分 类 号：R684.7[医药卫生—骨科学]