关节镜下有限切开内侧髌股韧带重建对复发性髌骨脱位患者的治疗疗效及应激因子的影响分析  

Effect of limited open reduction and reconstruction of the medial patellofemoral ligament on patients with recurrent patellar dislocation and its stress factors under arthroscopy

作　　者：朱志勇[1] 曾昭池[1] 阳波[1] 吴开元[1] 张先慧[1] 朱凡[1] 

机构地区：[1]解放军第169医院骨科,湖南衡阳421002

出　　处：《生物骨科材料与临床研究》2016年第1期29-32,35,I0005,共6页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨关节镜下有限切开内侧髌股韧带（Medial patellofemoral ligament,MPFL）重建对复发性髌骨脱位患者的治疗疗效,并分析该方案对患者应激因子的影响。方法选取我院2009年9月~2013年9月收治的71例复发性髌骨脱位患者,实施关节镜下有限切开MPFL重建治疗。对其进行为期1年的随访,观察其围术期应激因子变化及随访期间膝关节髌骨稳定性、膝关节评分变化。结果患者术前髌骨外推检验、恐惧试验、J-sign试验优良率均为0。术后6个月患者髌骨稳定性试验优良率均达100%,与治疗前比较差异有统计学意义（〈0.01）。患者术后6周Lysholm评分、HSS评分即显著上升（〈0.05）。患者术后6小时、术后1天血清应激反应因子ACTH、Cor、IL-6、IL-10、MDA均显著上升,NO显著下降（〈0.05）。术后3天患者血清应激反应因子水平与术前1天比较未见明显统计学差异（〉0.05）。患者术后7天SAS、SDS量表评分均较术前1天显著降低,差异有统计学意义（〈0.05）。结论关节镜下有限切开MPFL能够有效改善复发性髌骨脱位患者髌骨及膝关节稳定性,并能够在一定程度上控制应激反应因子水平稳定、缓解心理应激状态,对患者术后恢复及预后的改善均具有积极意义。Objective To analyze the effect of limited open reduction and reconstruction of the medial patellofemoral ligament（MPFL） on patients with recurrent patellar dislocation and its stress factors under arthroscopy. Methods 71 cases of patients with recurrent dislocation of the patella treated in our hospital during September 2009 to September 2013 were treated with limited open reduction and reconstruction of MPFL under arthroscopy. The patients were followed up for 1year. Changes of stress factors in perioperative period, the stability of the knee joint patella, knee joint score during follow-up was observed. Results The yield of preoperative patellar extrapolation test, J-sign test, test for fear was 0.Yield of patellar stability test was 100% 6 months after surgery, with significant difference compared with before treatment（ 〈0.01）. Lysholm score, HSS score significantly increased 6 weeks after operation（ 〈0.05）. Serum stress response factor ACTH, Cor, IL-6, IL-10, MDA significantly increased, and NO decreased significantly 6h and 1d after surgery（ 〈0.05）. There was no significant difference of serum stress response factor levels 3 days after surgery and 1 days before surgery（ 〉0.05）. SAS and SDS scale scores significantly decreased 7 days after surgery, with statistical significance（ 〈0.05）. Conclusion Limited open reduction and reconstruction of MPFL under arthroscopy could effectively improve stability of patella and knee joint. And it could control stability of stress factor levels and relieve psychological stress,which had positive significance for postoperative recovery and improving the prognosis.

关 键 词：关节镜 内侧髌骨韧带重建 复发性髌骨脱位 疗效 应激因子 

分 类 号：R687.4[医药卫生—骨科学]