髌骨外侧关节面成形联合外侧松解术治疗严重髌股关节炎  

Treatment of severe patellofemoral arthritis with lateral patellaplasty and lateral release

作　　者：叶培 董志兴 王立晖 林军 高立华 臧学慧 YE Pei;DONG Zhi-xing;WANG Li-hui;LIN Jun;GAO Li-hua;ZANG Xue-hui(Section Ⅱ,Dept of Orthopaedics,Nanhai Hospital Affiliated of Southern Medical University,Nanhai District People′s Hospital of Foshan City,Foshan,Guangdong 528200,China)

机构地区：[1]南方医科大学附属南海医院(佛山市南海区人民医院)骨二科,广东佛山528200 [2]南方医科大学附属南海医院(佛山市南海区人民医院)放射科,广东佛山528200

出　　处：《临床骨科杂志》2021年第6期802-805,共4页Journal of Clinical Orthopaedics

基　　金：广东省佛山市科技局医学类科技攻关项目(编号:1920001001280,1920001001814)。

摘　　要：目的探讨髌骨外侧关节面成形联合外侧松解术治疗严重髌股关节炎的临床疗效。方法采用髌骨外侧关节面成形联合外侧松解术治疗37例髌股关节炎患者。比较手术前后髌骨适合角(CA)、髌骨倾斜角(PTA)和髌骨外移(PLS);采用疼痛VAS评分、膝关节活动度(ROM)、髌骨改良Kujala评分、Lysholm评分、生活质量量表(SF-12)评分评价髌股关节、膝关节整体功能、生活质量的改善情况。结果患者均获得随访,时间5~18个月。术后髌骨轴位X线或膝关节CT检查显示髌股关节炎为改良IwanoⅡ期,髌股关节外侧间隙恢复。CA、PTA、PLS末次随访时均较术前明显减小(P<0.05);VAS评分末次随访时明显低于术前(P<0.01);ROM末次随访时明显大于术前(P<0.01);改良Kujala评分、Lysholm评分、SF-12评分末次随访时均明显高于术前(P<0.05)。结论髌骨外侧关节面成形联合外侧松解术治疗严重髌股关节炎,可减轻患者关节疼痛,增加膝关节屈曲度,有效改善髌股关节和膝关节功能,是一种简单、微创、安全有效的保膝手术。Objective To investigate the clinical effect of lateral patellaplasty combined with lateral release in the treatment of severe patellofemoral arthritis.Methods The 37 cases of patellofemoral arthritis were treated with lateral patellaplasty combined with lateral release.The changes of the patellar position were evaluated by comparing the patellar congruence angle(CA),patellar tilt angle(PTA)and patellar lateral shift(PLS)before and after the operation;pain visual analogue score(VAS),knee range of motion(ROM),modified Kujala score and Lysholm score of the patella,quality of life scale(SF-12)were used to evaluate the improvement sitation of whole function of patellofemoral joint and knee joint,quality of life.Results All patients were followed up for 5~18 months.Postoperative patellar axial X-ray or knee CT examination confirmed that the patellofemoral joint was at IwanoⅡ-stage,and the lateral space of the patellofemoral joint was significantly restored.At the last follow-up,CA,PTA,and PLS were significantly decreased than the preoperation(P<0.05);VAS and ROM were significantly improved than the preoperation(P<0.05);the modified Kujala score,Lysholm score,and SF-12 score were significantly increased than those before operation(P<0.05).Conclusions Lateral patellaplasty combined with lateral release are used to treat severe patellofemoral arthritis,which can reduce patient′s joint pain,increase knee flexion range,and effectively improve the function of patellofemoral joint and knee joint.It is a simple,minimally invasive,safe and effective knee-salvage surgery.

关 键 词：髌骨外侧关节面成形术 外侧松解术 髌股关节炎 膝关节 

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