关节镜下治疗髌股外侧高压综合征

目的 探讨关节镜下外侧支持带松解结合内侧支持带紧缩治疗髌股外侧高压综合征的效果和临床意义.方法 采用关节镜下外侧支持带松解结合内侧支持带紧缩术治疗25例（27膝） 髌股外侧高压综合征.男4例（4膝）,女21例（23膝）;单膝23例,双膝2例.物理检查见Q角增大（〉20°） 9膝,外侧支持带压痛17膝,被动髌骨倾斜试验阳性22膝,压髌试验阳性24膝.X线检查轴位片见髌股对合角异常16膝.术中在关节镜监视下,用等离子松解外侧支持带,必要时可向近端扩大松解范围,切断部分股外侧肌,达到完全松解;强生2号线紧缩髌股内侧支持带.结果 术后所有患者均得到随访,随访5～30个月;平均13.6个月.疗效评定参照Lysholm 评分标准,优15例,良5例,可3例,差2例,优良率为80.0%.Lysholm评分从术前48.0～72.0分、平均（63.2±3.8）分,提高至术后64.0～100.0分、平均（89.4±2.6）分,手术前后差异具有统计学意义（t=5.890,P〈0.05）.术后出现1例患者关节积血.结论 髌股外侧支持带松解结合内侧支持带紧缩术是一种微创的软组织平衡手术,能够有效地缓解髌股外侧高压综合征引起的髌股关节疼痛.     

髌骨外侧高压综合征的微创治疗

目的 评价关节镜下外侧支持带松解治疗髌骨外侧高压综合征(ELPS)的疗效.方法 2006年4月至2009年1月采用关节镜下外侧支持带松解术治疗47例ELPS患者,均诉膝前疼痛.Q角增大(＞20°)37例,外侧支持带部位压痛34例,髌骨被动倾斜试验阳性41例,髌骨滑动试验阳性40例,压髌试验阳性42例.X线片示结节-沟角大于10°者28例.20°位CT片均有髌骨倾斜角和外侧髌股角异常.术中在关节镜引导下,用射频消融电刀松解外侧支持带,切断部分股外侧肌,达到完全松解.结果 42例患者术后获12～19个月(平均15个月)随访.Lysholm评分标准评定:优26例,良9例,可5例,差2例,优良率为83.3%.Lvsholm评分从术前平均(65.1±4.3)分提高到术后平均(92.4±2.8)分,差异有统计学意义(t=5.980,P＜0.05).结论 关节镜下外侧支持带松解术是治疗ELPS的一种安全有效的方法,且并发症较少.     

关节镜下外侧支持带松解治疗髌骨外侧高压综合征

目的 探讨关节镜下髌骨外侧支持带松解治疗髌骨外侧高压综合征的方法和疗效.方法 自2011年3月至2012年7月,对59 例（62膝）髌骨外侧高压综合征患者在关节镜下行髌骨外侧支持带松解手术,男24 例,女35 例;年龄26～65 岁,平均47.6 岁.全部患者术后积极康复训练.结果 术后随访时间12～27个月,平均16个月.比较手术前后髌骨倾斜角、外侧髌股角结果具有统计学差异（P＜0.05）;IKDC膝关节功能主观评分、Lysholm功能评分术前、术后结果具有统计学差异（P＜0.05）.结论 关节镜下髌外侧支持带松解治疗髌骨外侧高压综合征具有创伤小、精确彻底、康复快、并发症少等优点,对于膝前区疼痛伴髌骨外侧倾斜且软骨退变轻的患者疗效满意.     

髌骨外侧支持带松解结合内侧皱缩术治疗髌股关节外侧挤压综合征

目的介绍关节镜下髌骨外侧支持带松解结合内侧皱缩术治疗髌股关节外侧挤压综合征的疗效。方法自2017-2018年共收治髌股关节外侧挤压综合征26例,男11例,女15例;年龄37~54岁,平均(40.0±1.3)岁。技术要点为关节镜下髌股外侧支持带囊外松解,内侧支持带皱缩术。患者病程10~28个月,平均(16.0±1.5)个月,手术前后根据Lysholm评分进行评价。结果术后26例获得6~12个月随访,平均随访时间(9.0±1.5)个月。Lysholm评分术前(64.53±3.25)分,末次随访评分为(90.75±4.11)分,手术前后比较差异有统计学意义(P<0.05)。结论关节镜下髌骨外侧支持带囊外松解结合内侧皱缩术治疗髌股关节外侧挤压综合征与传统术式相比显示了微创的优势,能获得满意的治疗效果。     

关节镜手术治疗老年性严重退行性髌骨外侧高压症

目的探讨关节镜下外侧支持带松解加清理术治疗老年性严重退行性髌骨外侧高压症的方法及疗效。方法对59例髌骨外侧高压合并髌股关节软骨退变严重的老年患者行关节镜下清理术的同时用射频刀松解外侧支持带。45例切开外侧支持带纤维,不切断股外侧肌(有限松解组);14例切开外侧支持带纤维并切断股外侧肌(完全松解组)。分别观察术后1、2年疼痛及上下楼改变情况和患者术后2年主观满意情况,术后股四头肌肌力恢复时间,手术前及手术后1、2年的Lysholm评分。结果 59例患者症状均改善,Lysholm评分:术前平均64.2分±6.5分,术后2年提高到平均82.8分±4.6分(P<0.05)。有限松解组平均提高18.5分±6.2分,完全松解组平均提高20.3分±8.2分,两组比较差异无统计学意义(P>0.05)。有限松解组患者肌力恢复时间为6.5个月,完全松解组肌力恢复时间为9.1个月,两组比较差异有统计学意义(P<0.05)。患者主观满意率为91.5%。结论对老年患者伴有髌股关节软骨退变严重的髌骨外侧高压症行关节镜下外侧支持带松解加清理术,能有效改善大部分患者的症状,使用外侧支持带有限松解术后恢复较快。     

关节镜下内侧髌股韧带重建和外侧支持带松解治疗复发性髌骨脱位

目的:评价内侧髌股韧带重建联合外侧支持带松解治疗复发性髌骨脱位的临床效果.方法:2011年3月至2013年6月在关节镜下进行内侧髌股韧带重建联合外侧支持带松解治疗复发性髌骨脱位15例,男5例,女10例;年龄14～32岁,平均19.4岁;髌骨脱位2次及以上.术前常规行X线、CT、MR检查了解髌股关节及内侧髌股韧带情况,关节功能Lysholm评分69.85±11.52,术中镜下查看髌股对合关系及髌骨运动轨迹.术中使用自体腘绳肌腱重建内侧髌股韧带同时关节镜下外侧支持带松解.结果:所有患者获随访,时间12～36个月,平均27.6个月,患者无再发髌骨脱位及半脱位,伸直位及屈曲30°位恐惧试验和髌骨外移试验均为阴性,术后12个月患者完全恢复正常活动,膝关节无主观不适,术后Lysholm评分92.60±5.75,较术前提高.结论:关节镜下内侧髌股韧带重建联合外侧支持带松解手术能有效治疗复发性髌骨脱位,缓解症状,重建髌骨稳定性.     

关节镜下外侧支持带松解联合Fulkerson截骨术治疗髌股关节紊乱症

目的　探讨关节镜下外侧支持带松解联合Fulkerson截骨术治疗髌股关节紊乱症的疗效。方法　对一组 32例 39膝术前行常规髌骨动力性CT扫描测量髌股适合角 (CA)髌股外侧倾角 (LPFA)和髌骨倾斜角 (P -TA)。均在关节镜下关节腔内行外侧支持带松解联合Fulkerson截骨术。结果　术后平均随访 1 0 6个月 ,32例症状明显改善 ,未发生胫骨骨折病例。复查动力性髌骨CT测量髌股适合角 ,外侧髌股角和髌骨倾斜角较术前明显改善 (P <0 0 1 )。结论　该方法同时解决了近端和远端重排列问题 ,并纠正了动态和静态排列异常 ,消除了异常应力 ,解除了症状。两种术式的结合其疗效是相加的 ,最终有利于提高髌股关节紊乱症的疗效     

关节镜下经关节囊内与囊外松解髌外侧支持带治疗髌骨外侧高压症的疗效比较

目的比较关节镜下经关节囊内与关节囊外松解髌外侧支持带治疗髌骨外侧高压症的临床疗效。方法回顾性分析自2016-01—2019-01采用关节镜下髌外侧支持带松解术治疗的40例Ⅰ期髌骨外侧高压症,20例进行关节囊外松解(囊外松解组),20例进行关节囊内松解(囊内松解组)。比较囊外松解组与囊内松解组疼痛消失时间、恢复运动时间、术后1年膝关节功能Lysholm评分。结果 40例均获得随访,随访时间平均15(13~18)个月。所有患者术后复查MRI显示膝关节外侧间隙骨水肿容积减小,水平轴位像显示髌股关节对合关系改善。囊外松解组术后疼痛消失时间、恢复运动时间均短于囊内松解组,术后1年膝关节功能Lysholm评分高于囊内松解组,差异有统计学意义(P<0.05)。结论关节镜下关节囊外松解髌外侧支持带治疗髌骨外侧高压症较囊内松解可取得更好的疗效,而且术中医源性损伤更小。     

关节镜辅助下三联术治疗复发性髌骨脱位

目的探讨关节镜辅助下三联术治疗复发性髌骨脱位的疗效。方法对18例复发性髌骨脱位患者在关节镜辅助下行外侧支持带松解、内侧髌股韧带重建及改良Fulkerson截骨三联术。术后进行髌骨外推恐惧试验,观察再脱位率,测量髌股适合角和外侧髌股角,采用Lysholm和Kujala评分评价膝关节功能。结果患者均获得随访,时间6~36个月。术后6个月内,有2例出现髌骨外侧疼痛,经康复理疗后均逐渐好转或消失。18例患者术后恐惧试验均阴性,随访期间无髌骨再脱位,Q角在正常范围。末次随访时患膝CT显示:髌股适合角5.83°±2.46°、外侧髌股角3.52°±0.64°、Lysholm膝关节功能评分93.28分±3.32分;Kujala髌股关节评分92.15分±12.43分,与术前比较差异均有统计学意义(P0.05)。结论关节镜辅助下三联术治疗复发性髌骨脱位能恢复髌股关节功能并有效防止复发。     

关节镜下髌骨外侧支持带松解加清理术治疗髌骨外侧高压综合征

目的探讨关节镜下髌骨外侧支持带松解加清理术治疗髌骨外侧高压综合征的方法及疗效。方法自2004年9月至2008年5月对96例髌骨外侧高压综合征患者行关节镜下联骨外侧支持带松解加清理术,男34例,女62例;年龄51～65岁,平均58岁。左膝46例,右膝50例。术后积极进行康复训练。采用Lysholm膝关节功能评分评价疗效。结果术后随访时间14～36个月,平均25个月。术后1个月所有患者膝关节疼痛明显减轻或消失,1年后74例疼痛基本消失。Lysholm评分,优64例,良18例,可10例,差4例,优良率85．4％,患者主观满意率为95．8％。结论关节镜下松解髌外侧支持带治疗髌骨外侧高压综合征具有创伤小、康复快等优点,并可同时在关节镜下进行关节清理术,对髌股疼痛伴有髌骨向外侧倾斜且关节软骨退变较轻的病例,疗效良好。术后采取积极的康复训练会明显提高疗效。     

关节镜下髌骨外侧支持带松解术治疗髌骨倾斜挤压综合征

目的探讨关节镜下髌骨外侧支持带松解术治疗髌骨倾斜挤压综合征的效果。方法对14例髌骨倾斜挤压综合征患者15个膝关节行关节镜下髌骨外侧支持带松解术。手术前后按Lysholm膝关节功能评分进行评估。屈膝20°位CT片测量手术前后髌骨倾斜角（PTA）、外侧髌股角（LPFA）。结果14例均获6-18个月随访,Lysholm评分术前为54.53分±5.54分,术后6个月为88.73分±7.0分（P〈0.01）;PTA术前为2.78°±0.40°,术后为18.53°±0.83°（P〈0.01）;LPFA术前为0.97°±0.47°,术后为8.32°±0.63°（P〈0.01）。结论关节镜下髌骨外侧支持带松解术能有效纠正髌骨倾斜,缓解疼痛,恢复膝关节运动功能,且创伤小,并发症少。     

内侧髌股韧带重建联合胫骨结节移位和关节镜下外侧支持带松解术治疗持久性髌骨脱位

目的观察内侧髌股韧带重建联合胫骨结节移位和关节镜下外侧支持带松解术治疗持久性髌骨脱位的效果。方法对6例持久性髌骨脱位患者的10个膝关节行内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术。手术前后采用Lysholm膝关节功能评价表和Kujala评分表进行评估,并通过CT观测手术前后髌骨外移度。结果 6例均获随访,时间24～36(29±7.21)个月。Lysholm评分术前为47.10分±10.31分,术后24个月为83.11分±5.21分,差异有统计学意义(P<0.05);Kujala评分术前为41.26分±13.36分,术后24个月为82.33分±5.31分,差异有统计学意义(P<0.05)。患膝运动能力均较术前明显改善。髌骨外移度术前为35.61 mm±5.37 mm,术后为4.30mm±1.13mm,差异有统计学意义(P<0.05)。结论内侧髌股韧带重建联合胫骨结节移位和关节镜下髌骨外侧支持带松解术能够有效纠正持久性髌骨外侧脱位,缓解症状,恢复膝关节功能。     

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

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。     

Influence of arthroscopic lateral release on functional recovery in adolescents with recurrent patellar dislocation

Introduction

The aim of this study is to prove the influence of the arthroscopic lateral release on functional recovery in adolescents with recurrent lateral dislocation of patella.

Materials and methods

From 2006 to 2009, arthroscopic release of the lateral retinaculum was done on 27 adolescent patients (24 women, 3 men) and 33 knees (in 6 patients on both knees). All of them were active in different sports. The severity of patellar subluxation and dislocation was analysed on X-ray; the Q angle, congruence angle, sulcus angle, patellofemoral angle and height ratio were measured. Functional scores (Lysholm, Kujala, Tegner) were measured preoperatively and postoperatively. The average duration of clinical and X-ray follow-up was 4.5 years (range 3–6 years).

Results

The mean age of the patients was 14.56 years (range 11–18 years). There was an average of 4.16 dislocations (range 2–28 dislocations) before surgery. The mean Lysholm score improved from 64 to 95 (p = 0.0002), and the mean Kujala score improved from 66 to 94 (p < 0.0001). Congruence angle and lateral patellofemoral angle improved but without any significant differences.

Conclusion

Arthroscopic lateral release successfully treats recurrent patellar dislocations in adolescents, influences functional recovery and improves knee function.     

Evaluation of patients with persistent symptoms after lateral retinacular release by kinematic magnetic resonance imaging of the patellofemoral joint

The arthroscopic lateral retinacular release is typically performed to treat patellar pain and instability. This procedure was previously considered to be relatively benign with a low associated complication rate. However, a high incidence of medial subluxation of the patella was recently reported in patients with persistent symptoms after lateral retinacular release. Because the use of physical examination criteria may not always be sufficient to assess patellar alignment, 40 patients (43 knees) were evaluated by the newly developed technique of kinematic magnetic resonance imaging of the patellofemoral joint. One (2%) patellofemoral joint had normal patellar alignment, 10 (23%) had lateral subluxation of the patella, 1 (2%) had excessive lateral pressure syndrome, 27 (63%) had medial subluxation of the patella, and 4 (9%) had lateral-to-medial subluxation of the patella. Seventeen of 40 patients (43%) with unilateral arthroscopic lateral retinacular releases had medially subluxated patellae on the unoperated joints. Because patellar malalignment commonly affects bilateral joints, medial subluxation of the patella may have been present before the lateral retinacular release but was not recognized in these patients.     

关节镜下内侧髌股韧带紧缩并外侧髌韧带松解治疗髌股关节疼痛综合征临床对照试验

目的：探讨关节镜下内侧髌股韧带紧缩并外侧髌韧带松解治疗髌股关节疼痛综合征的手术疗效。方法：将100例髌股关节疼痛综合征患者随机分为治疗组和对照组各50例，男35例，女65例；年龄50-70岁，平均63岁。手术均在关节镜下进行，治疗组采用内侧髌股韧带紧缩、外侧髌韧带松解术式；对照组采用临床广泛使用单一外侧髌韧带松解手术。结果：随访平均13个月，采用HSS（hospitalforspecialsurgery）慢性疾病及关节炎评估系统评价疗效，治疗组平均积分（73．52±11．17）分；对照组平均积分（65．50±13．70）分（P〈O．05）。结论：内侧髌股韧带紧缩并外侧髌韧带松解治疗髌股关节疼痛综合征临床疗效满意。与外侧髌韧带松解术式相比，更能纠正髌股关节的病理运动轨迹，使髌股关节内外侧间隙平衡更为容易，对髌前疼痛的缓解更有效，术后无关节内血肿、髌骨坏死和髌骨脱位等并发症发生。     

Lateral retinacular release for intractable lateral retinacular pain

Lateral retinacular release was performed in a series of patients with intractable lateral retinacular pain characterized by tenderness localized in some portion of the lateral retinaculum. Patients with other patellofemoral problems were excluded. Of 14 knees, 79% responded favorably. Lateral retinacular release may be best indicated in patients with less severe malalignment of the patella and intractable pain in the lateral retinaculum.     

Long-term functional outcome after lateral patellar retinacular release in adolescents: an observational cohort study with minimum 5-year follow-up

BACKGROUND: Lateral patellar retinacular release has been recommended for patients with patellar tilt, tight lateral retinaculum, patellar subluxation, patellar dislocation, and patellofemoral pain. Studies of long-term outcomes after lateral release are limited, especially for differing indications. HYPOTHESIS: Adolescents do well after lateral retinacular release in the 5- to 22-year time frame. METHODS: Patients having undergone lateral retinacular release between the years of 1981 and 1999 were contacted. Evaluation was by the Cincinnati and Lysholm scales and by level of satisfaction and need for reoperation. RESULTS: One hundred forty knees were studied. Mean age at operation was 15.4 years (SD, 2.7 years). Average follow-up was 8.5 (SD, 4.1 years; range, 5.2-22.5 years). Twenty-five patients had needed reoperation, indicating failure of the index operation. Kaplan-Meier survivorship was 78% at 15 years. Cincinnati and Lysholm scores indicated well-functioning knees in those not requiring reoperation. Overall satisfaction improved as time from operation increased.Comparisons were made between the group requiring reoperation and those who did not. Focus was placed on knees with patellar maltracking or tilt versus patellar instability and between males and females. No differences were found among groups for reoperation rate, level of satisfaction, average Lysholm score, or average Cincinnati score. There were no differences in demographics or outcome measures between patients with patellar instability and those with tilt. Instability patients trended toward higher reoperation rates than did tilt patients, but the difference was not significant. There were no differences between males and females. CONCLUSION: The majority of patients are satisfied with their knee 5 to 22 years after lateral patellar retinacular release and scored well on questions rating knee health and function.     

关节镜下髌外侧支持带松解及内侧支持带紧缩治疗髌骨软化症

目的探讨膝关节镜下外侧支持带松解及内侧支持带紧缩治疗髌骨软化症的疗效。方法对31例(36膝)髌骨软化症患者在关节镜下用等离子刀松解外侧支持带及外侧髌—股韧带,同时紧缩缝合内侧支持带及内侧髌—股韧带。结果随访10～48个月,患者症状和体征均得到明显改善。与术前相比,Lysholm评分由70.2分提高至平均92.1分,差异有显著性(P<0.01)。结论该术式治疗髌骨软化症不仅能松解外侧支持带,同时还可有效地紧缩内侧支持带,疗效确切,具有创伤小、并发症少、功能恢复快等优点。