关节镜下髌骨成形联合外侧支持带松解对髌股关节炎患者的临床疗效分析  

Clinical Efficacy Analysis of Arthroscopic Patelloplasty Combined with Lateral Retinaculum Release in Patients with Patellofemoral Arthritis

作　　者：张璇 姚五平[2] 李玉吉[2] 王宇杰 方雨婷 赵兴龙 柳直[2] Zhang Xuan;Yao Wuping;Li Yuji;Wang Yujie;Fang Yuting;Zhao Xinglong;Liu Zhi(Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China;Second Department of Joint and Bone,Gansu Provincial Hospital of Traditional Chinese Medicine,Lanzhou 730050,China)

机构地区：[1]甘肃中医药大学,甘肃兰州730000 [2]甘肃省中医院关节骨二科,甘肃兰州730050

出　　处：《实用骨科杂志》2023年第8期703-708,共6页Journal of Practical Orthopaedics

基　　金：甘肃省中医药管理局项目(GZKP-2020-18);中医药传承创新平台建设项目(甘卫中医函[2020]203号);兰州市科学技术局医疗卫生专项(2021-1-87)。

摘　　要：目的探讨采用关节镜下髌骨成形联合外侧支持带松解对髌股关节炎患者临床疗效以及影像学与步态之间的相关性研究。方法本研究选取2020年12月至2022年1月甘肃省中医院关节骨科确诊为髌股关节炎行关节镜手术的患者共75例,其中男32例,女43例;年龄42~67岁,平均(56.10±8.17)岁;病程3.4~5.7年,平均(4.20±2.44)年;左膝42例,右膝33例。所有患者在术前、术后6个月、术后12个月摄膝关节负重正侧位X线片、30°髌骨轴位X线片、膝关节CT,术前、术后12周行步态检测,测量相应的Insall指数、Peel指数、外侧髌骨角、髌股适合角、髌骨倾斜角等影像学指标以及双脚的步距、步频、步速、支撑时间、重量分配等步态参数,并对影像学指标与步态参数进行Pearson相关性分析。结果对比治疗前后影像学指标及步态参数,治疗后患者Insall指数、Peel指数、髌股适合角指数、外侧髌骨角指数、髌骨倾斜角指数较治疗前均有显著改善,差异有统计学意义(P<0.05)。对比患者治疗前后双脚的步距、步频、支撑时间、重量分配等步态参数,术后患者步态改善明显,差异有统计学意义(P<0.05)。经过Pearson相关性分析,影像学指标改善与步态参数存在一定相关性,其中外侧髌骨角与步态呈正相关,相关系数(r值)范围为0.512~0.682,与步速相关性最高;而Insall指数、Peel指数、髌股适合角、髌骨倾斜角呈负相关,相关系数(r值)范围为-0.831~-0.143,与重量分配相关性最高。结论关节镜下髌骨成形联合外侧支持带松解对髌股关节炎患者影像学及步态改变有改善,且影像学指标与步态存在一定相关性。Objective To investigate the clinical efficacy of arthroscopic patelloplasty combined with lateral retinaculum release in patients with patellofemoral arthritis and the correlation between imaging and gait.Methods From December 2020 to January 2022,a total of 75 patients with patellofemoral arthritis diagnosed in the Department of Orthopedics in Gansu Provincial Hospital of Traditional Chinese Medicine were selected.32 males and 43 females were included.The average age was(56.10±8.17)years old,ranging from 42 to 67 years old.The average course of disease was(4.20±2.44)years.There were 42 cases of left knee and 33 cases of right knee.anteroposterior and lateral X-ray,30°patellar axial X-ray and knee CT examations were performed before surgery,6 months and 12 months after surgery.Gait tests were performed before surgery and 12 weeks after surgery.The corresponding Insall index,peel index,lateral patellar angle,patellofemoral fit angle,patellar tilt angle and other imaging indicators,as well as gait parameters such as foot distance,gait frequency,gait speed,support time and weight distribution were measured.Pearson correlation analysis was performed between imaging parameters and gait parameters.Results By comparing the imaging indexes and gait parameters before and after treatment,the Insall index,peel index,patellofemoral fitness angle index,lateral patellar angle index and patellar tilt angle index after treatment were significantly improved compared with those before treatment,and the difference was statistically significant(P<0.05).After treatment,the gait parameters of patients'feet,such as stride distance,gait frequency,support time,weight distribution,were compared before and after treatment.The gait of patients improved significantly after operation,and the difference was statistically significant(P<0.05).Pearson correlation analysis showed that there was a certain correlation between the improvement of imaging indicators and gait parameters.The lateral patellar angle was positively correlated with gait,

关 键 词：髌股关节炎 关节镜手术 步态分析 影像学改变 相关性 

分 类 号：R684.3[医药卫生—骨科学]