胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效研究  

Arthroscopic patellar retinaculum adjustment and tibial tubercle anteromedial transfer in recurrent patellofemoral dislocations

作　　者：付国建[1] 李苏皖[1] 刘朝晖[1] 张国桥[1] 陈小强[1] 

机构地区：[1]安徽省马鞍山市人民医院关节外科,243000

出　　处：《中华关节外科杂志（电子版）》2014年第4期30-33,共4页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨胫骨结节内移抬高术联合关节镜下髌骨支持带调整术治疗复发性髌骨脱位的疗效。方法自2008年至2012年对12例复发性髌骨脱位行关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术。术后6周、3个月、6个月、12个月、2年、5年进行门诊随访,物理检查包括髌骨内移度检查,髌骨外推恐惧试验,复查轴位X线片了解截骨块愈合情况、髌股关节适合角、髌骨指数,Lysholm膝关节功能评价表、IKDC评分和Kujala评分表进行评估。结果所有患者均获随访,随访时间1~5年,平均2.0年。术后3~6个月复查X线片见截骨块以达到骨性愈合,在负重行走并行膝关节屈伸功能锻炼,膝关节功能恢复良好。术后髌骨内移度均介于1°~2°之间,术后各时间点髌骨外推恐惧试验阳性率、髌骨适合角、髌骨指数与术前比较,差异均有统计学意义（P〈0.05）;术后各时间点间比较,差异均无统计学意义（P〉0.05）。术后6、12个月,IKDC、Lysholm、Kujala评分均较术前显著提高,差异均有统计学意义（P〈0.05）。术后6、12个月IKDC、Lysholm评分比较,差异无统计学意义（P〉0.05）。术后12个月Kujala评分较术后6个月显著提高,差异有统计学意义。结论关节镜下髌骨外侧支持带松解、内侧支持带紧缩联合胫骨结节内移抬高术能够有效治疗复发性髌骨脱位。Objective To evaluate the results of a tibial tubercle anteromedial transfer technique and arthroscopic patellar retinaculum adjustment in the treatment of recurrent patellofemoral dislocations . Methods The study included 12 knees of 12 patients （ eight males , four females;mean age of 20 years;range, 17 to 28 years ） who were operated on by the same surgeon for the patellofemoral alignment disorders.All the knees were treated by arthroscopic patellar retinaculum adjustment including the medial retinaculum placation , lateral retinaculum releasing , and the tibial tubercle anteromedial transfer .The follow-up period was from three weeks to 12 months postoperatively .The axial radiographic scans were done to measure the bone healing at the site of osteotomy , the patellar congruence angle and patellar index;Lysholm knee score , IKDC score and Kujala score were also evaluated .Results The mean follow-up period was two years （ range, one to five years ） .The radiographic scans showed that the osteotomy site achieved bone healing in three to six months after the surgery .The function of the knee was very well .The medial shift of the patella was 1＆#176;-2＆#176;postoperatively.At each postoperative time point, the positive apprehension test of patella , the patellar congruence angle , and the patellar index were statistically significant （ P〈0.05） compared with the preoperative data .The comparison between the time points after the surgery showed no significant differences （P〉0.05）.In the 6th and 12th month after the surgery, IKDC, Lysholm, and Kujala scores were significantly improved compared with the preoperative ones , and the differences were statistically significant （P〈0.05）.Yet comparing the data of the postoperative 6th and 12th month, the differences of the IKDC , Lysholm scores between the two time points were not statistically significant （P 〉0.05）.The postoperative Kujala score of the 12th month was remarkably improved, compared to that of the 6th month, and the differ

关 键 词：复发性 髌骨脱位 关节镜 

分 类 号：R687.3[医药卫生—骨科学]