关节镜手术治疗老年性严重退行性髌骨外侧高压症  

Arthroscopic treatment for elevated lateral pressure syndrome with severe patellofemoral arthritis in old age

作　　者：林建宁[1] 孙笑非[1] 阮狄克[1] 

机构地区：[1]海军总医院骨科,北京100048

出　　处：《临床骨科杂志》2012年第5期537-539,共3页Journal of Clinical Orthopaedics

摘　　要：目的探讨关节镜下外侧支持带松解加清理术治疗老年性严重退行性髌骨外侧高压症的方法及疗效。方法对59例髌骨外侧高压合并髌股关节软骨退变严重的老年患者行关节镜下清理术的同时用射频刀松解外侧支持带。45例切开外侧支持带纤维,不切断股外侧肌(有限松解组);14例切开外侧支持带纤维并切断股外侧肌(完全松解组)。分别观察术后1、2年疼痛及上下楼改变情况和患者术后2年主观满意情况,术后股四头肌肌力恢复时间,手术前及手术后1、2年的Lysholm评分。结果 59例患者症状均改善,Lysholm评分:术前平均64.2分±6.5分,术后2年提高到平均82.8分±4.6分(P<0.05)。有限松解组平均提高18.5分±6.2分,完全松解组平均提高20.3分±8.2分,两组比较差异无统计学意义(P>0.05)。有限松解组患者肌力恢复时间为6.5个月,完全松解组肌力恢复时间为9.1个月,两组比较差异有统计学意义(P<0.05)。患者主观满意率为91.5%。结论对老年患者伴有髌股关节软骨退变严重的髌骨外侧高压症行关节镜下外侧支持带松解加清理术,能有效改善大部分患者的症状,使用外侧支持带有限松解术后恢复较快。Objective To study arthroscopic lateral retinacular release and debridement in elevated lateral pressure syndrome （ELPS） with severe patellofemoral arthritis in old age. Methods 59 cases of old patients with ELPS were undergone arthroscopic patellar lateral retinacular release and debridement. In 45 cases patellar lateral retinaculum were released and musculus vastus lateralis were protected（ Group limited-release） ; in 14 eases（ Group total-release） patellar lateral retinaculum and musculus vastus lateralis were released. Symptoms changed and subjective patient sat- isfactions were observed in 1,2 years postoperatively. Results Good outcome in pain relief and improved ability to go up/down stairs. Lysholm scores were 64. 2 ± 6. 5 preoperatively to 82. 8 ± 4. 6 postoperatively （P 〈 0. 05 ）. In group limited-release, Lysholm scores increased 18.5 ± 6. 2 postoperatively while in group total-release Lysholm scores increased 20.3 ±8.2 （ P 〉 0.05 ） Muscle strength returned to normal 6. 5 months postoperatively in group limited-release,9. 1 months in group total-release（P 〈 0. 05）. Subjective patient satisfaction rate was 91.5%. Conclusions Arthroscopic lateral retinacular release and debridement surgery is an effective method for ELPS with severe patellofemoral arthritis in old age. Limited retinacular release is benefit to sooner recovery.

关 键 词：髌股关节炎 髌骨外侧高压症 外侧支持带松解 老年患者 

分 类 号：R684.3[医药卫生—骨科学] R687.4[医药卫生—外科学]