关节镜联合胫骨高位截骨术对髌骨位置及髌股关节功能影响的早中期回顾性研究  

An early and mid-term retrospective study of the effects of arthroscopy combined with high tibial osteotomy on patellar position and patellofemoral joint function

作　　者：庄万强 唐毅[1] 骆勇刚[1] 张辉[1] Zhuang Wanqiang;Tang Yi;Luo Yonggang;Zhang Hui(Department of Orthopedics,the People’s Hospital of Jianyang City,Jianyang 641400,Sichuan Province,China)

机构地区：[1]简阳市人民医院骨科,四川简阳641400

出　　处：《中国临床解剖学杂志》2024年第1期77-82,共6页Chinese Journal of Clinical Anatomy

基　　金：四川省医学会骨科专项科研项目(2019SAT21)。

摘　　要：目的探讨髌骨位置的改变是否会对髌股关节和功能产生不利影响。方法回顾性纳入2018年03月-2021年03月于本研究中心接受关节镜联合胫骨高位截骨术的患者。初次手术和内固定取出过程中进行关节镜诊断,比较各关节软骨状况及临床结果,采取影像学测量,评估髌骨位置变化。探究关节软骨状态与功能的关系。结果共纳入接受关节镜联合胫骨高位截骨术的患者60名,其中男性18例,女性42例,平均年龄(58.6±7.2)岁,平均随访时间(26.8±8.5)月。患者接受手术后,髌骨高度InsallSalvati Index并无统计学差异,Blackburne-Peel index指数由术前的(0.90±0.11)变为(0.81±0.13)。通过二次关节镜检查,依据国际软骨修复协会软骨损伤评分系统评估,股骨内侧髁的软骨状况从3.81改善至3.35(P=0.005),胫骨内侧平台的软骨状况从3.75改善至3.48(P=0.005)。股骨外侧髁的平均ICRS评分从0.15下降到0.43(P=0.004),胫骨外侧髁的平均ICRS评分从0.38下降到0.96(P<0.001)。髌骨侧平均ICRS分级为2.29~2.31,股骨滑车平均ICRS分级为2.18~2.25。膝关节功能评分较术前明显改善。结论关节镜联合胫骨高位截骨术后,尽管髌骨位置会出现影像学改变,但髌股关节软骨未见明显损伤及退化,膝关节功能尤其髌股关节功能未受到髌骨位置改变影响。Objective To investigate whether the changes in patellar position affect patellofemoral joint function and functional outcomes or not.Methods Patients who underwent arthroscopy combined with high tibial osteotomy(ACHTO)from March 2018 to March 2021 were enrolled in a retrospective study.Arthroscopic diagnosis was performed during primary surgery and internal fixation removal,and the status of articular cartilage and clinical outcomes were compared.Imaging measurements were also taken to evaluate changes in patellar position.At the same time to explore the relationship between articular cartilage status and function.Results A total of 60 patients who received arthroscopy combined with high tibial osteotomy were included in this study,including 18 male patients and 42 female patients,with an average age of(58.6±7.2)years and an average follow-up time of(26.8±8.5)months.After underwent ACHTO surgery,there was no statistical difference in the patellar height index ISI,and the BPI index changed from the preoperative(0.90±0.11)to(0.81±0.13).By secondary arthroscopy,the cartilage condition of the medial femoral condyle improved from 3.81 to 3.35(P=0.005)and that of the medial tibial plateau from 3.75 to 3.48(P=0.005)as assessed by the ICRS scoring system.The mean ICRS score of the lateral femoral condyle decreased from 0.15 to 0.43(P=0.004),and the mean ICRS score of the lateral tibial condyle decreased from 0.38 to 0.96(P<0.001).The average ICRS grading of the patellar side was 2.29-2.31 and the average ICRS grading of the femoral trochlea was 2.18-2.25.Knee functional scores were significantly improved compared with those before operation.Conclusions After arthroscopy combined with high tibial osteotomy,no obvious damage or degeneration of patellofemoral cartilage is observed.Moreover,the knee function,especially the patellofemoral joint function,was not affected by the change of patellar position.

关 键 词：关节镜联合胫骨高位截骨术 髌骨位置 关节软骨 

分 类 号：R687.31[医药卫生—骨科学]