关节镜辅助下三联手术治疗复发性髌骨脱位

目的探讨关节镜辅助下三联手术治疗复发性髌骨脱位的近期疗效。方法对23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截骨术。术后随访,评估影像学检查结果、Tegner下肢运动能力主观评分、Lysholm膝关节功能综合评分和Kujala髌股关节评分。结果 23例均获随访,时间12~36(24.3±7.82)个月。患者无髌骨再脱位或半脱位,Q角在正常范围。患膝CT显示,髌骨/股骨滑车适配角从术前13.30°±5.15°改善至末次随访时5.72°±3.32°(P0.01),髌股关节外侧张开角从术前0.70°±2.85°改善至末次随访时8.13°±2.75°(P0.01)。Lysholm评分从术前47.92分±16.23分提高至末次随访时93.27分±7.91分(P0.01);Tegner评分从术前5.32分±1.10分提高至末次随访时6.37分±0.83分(P0.01);Kujala髌股关节评分从术前55.3分±11.23分提高至末次随访时83.2分±13.91分(P0.01)。结论关节镜辅助下三联手术治疗复发性髌骨脱位能有效防止复发和恢复髌股关节功能,疗效满意。

Treatment of recurrent patellar dislocation through arthroscopic assisted triple surgery LUO Yuan-ming,XU Yue-gen,LU Hou-wei,JIANG Chun-yu

Objective To investigate the short-term results of treating the recurrent patellar dislocation by arthroscop-ic assisted triple surgery.Methods 23 patients of recurrent patellar dislocation patellar were treated by arthroscopic lateral retinaculum release,reconstruction of the medial patellfemoral ligament （MPFL）combined with improved Fulkerson′s osteotomy.Image examination,activity level of the patients （Tegner activity score）,functional evaluation （Lysholm score and Kujala score）,subjective assessment and clinical results were comprehensive evaluated in these patients.Results The patients were followed up for 12-36（24.3 ±7.82）months.At the end of follow-up,there were no patients with redislocation and subluxation,quadriceps angle were improved to normal range,the mean con-gruence angle（CA）were improved from 13.30°±5.15°to 5.72°±3.32°（P〈0.01）,the mean lateral patellofemo-ral angle（LPA）were improved from 0.70°±2.85°to 8.13°±2.75°（P〈0.01）,the mean Lysholm score were im-proved from 47.92 ±16.23 to 93.27 ±7.91（P〈0.01）,the mean Tegner score were improved from 5.32 ±1.10 to 6.37 ±0.83（P〈0.01）,the mean Kujala score were improved from 55.3 ±11.23 to 83.2 ±13.91（P〈0.01）. Conclusions The treatment of recurrent patellar dislocation through arthroscopic assisted triple surgery is effective to prevent recurrence and restore knee function to the greatest extent.