关节镜下内侧紧缩及外侧松解加半髌腱止点移位术治疗复发性髌骨脱位

目的 评价微创关节镜下外侧松解、内侧紧缩、半髌腱止点移位术的三联手术方案治疗复发性髌骨脱位的临床疗效.方法 以1998～2008年收治的71例（77膝）复发性髌骨脱位患者为研究对象,入选标准为：胫骨骨骺已经闭合,且股骨滑车沟无严重发育不良和严重膝外翻畸形.男11例,女60例;平均年龄19.5岁,67例有明确外伤史.术前测量Q角.Merchant位X片上测量股骨滑车沟角、髌骨-股骨滑车适合角,髌股外侧角.CT平扫测量股骨髁滑车凹中心与胫骨结节水平距离（TT TG）.术中采用外侧松解、内侧紧缩和半髌腱止点移位三联手术方案.结果 2例（2膝）失访,69例（75膝）术后随访2～12年,平均5.2年.除早期1例患者在术后2个月再次发生髌骨脱位外,其余病例术后髌骨脱位未见复发.术前髌骨-股骨滑车适合角（24.2°±6.8°）,术后为（-2.1°±5.8°）（P〈0.05）;术前髌股外侧角（-2.0°±5.2°）,术后为（10.9°±4.0°）（P〈0.05）;术前TT TG平均为（19.8±2.1） mm,术后为（13.6±1.8） mm （P〈0.01）.术前Lysholm评分和IKDC评分分别由术前的（45.6±4.8）、（48.3±6.8）分,提高到术后的（92.3±10.8）分 （P〈0.05）和（94.3±8.4）分（P〈0.05）;术前测量Q角男性平均为（13.2°±3.1°）,术后平均为（9.2°±2.8°）（P〈0.05）;女性平均为（21.0°±5.2°）,术后平均为（15.4°±4.4°）（P〈0.05）.结论 关节镜下外侧松解、内侧紧缩缝合、半髌腱移位术的综合手术方案治疗复发性髌骨脱位创伤较小,疗效确切,术后患者膝关节功能改善明显,手术操作简便,易于掌握.

Arthroscopic treatment of recurrent patella dislocation by lateral retinacular release and medial retinacular tightening plus medial transfer of semi tibial tuberosity

Objective To evaluate the therapeutic effects of compound operative protocols, including the lateral retinacular release and the medial retinacular tightening plus the medial transfer of the semi tibial tuberosity under the anthroscope, for the recurrent patella dislocation.Methods From 1998 to 2008, 71 patients with the recurrent patella dislocation were treated by arthroscope with the lateral retinacular release and the medial retinacular tightening plus the medial transfer of the semi tibial tuberosity. The inclusion criteria were as follows： the tibial tuberosity epiphysis has closed, the femoral trochlear groove has no severe dysplasia and there is no severe valgus deformity in the knee. There were 11 males and 60 females. The average age was 19.5 years old. 67 of them had a definite history of trauma. The Merchant X ray was taken to evaluate the femoral trochlear groove sulcus angle, patella femoral trochlear congruence angle, lateral patellofemoral angle. The CT scan was taken to measure the tibial tubercle to trochlear groove （TT TG） distance. Results 69 patients （75 knees） were follow up for an average time of 5.2 years （range, 2 to 12）. All the cases had no recurred dislocation except one. The X ray showed that the patella femoral trochlear congruence angle improved from （24.2°±6.8°） to （-2.1°± 5.8°） （P〈0.05）, and the lateral patellofemoral angle improved from （-2.0°±5.2°） to （10.9°±4.0°） （P〈0.05）. The TT TG distance improved from （19.8±2.1） mm to （13.6±1.8） mm （P〈0.01）. The mean Lysholm scores and IKDC scores improved from （45.6±4.8） and （48.3±6.8） to （92.3±10.8） （P〈0.05） and （94.3±8.4） （P〈0.05）, respectively. The Q angle improved from （13.2°±3.1°） to （9.2°±2.8°） in male （P〈0.05） and from （21.0°±5.2°） to （15.4°±4.4°） in female （P〈0.05）. Conclusion The compound operative protocols for the recurrent patelar dislocations with the lateral retinacular release and the medial retinacular tightening plus the medial transfor of the semi tibial tuberositv under arthroscope are not difficult but can result in positive effects on the recurrent patella dislocation.