关节镜下外侧支持带松解治疗髌骨外侧高压综合征

目的探讨关节镜下外侧支持带松解治疗髌骨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术治疗39例(51膝)髌骨外侧高压综合征.男1例(1膝),女38例(50膝);单膝27例,双膝12例;平均年龄49.6岁(28～71岁).临床症状以髌股关节钝痛为特点,疼痛位置不易确定,髌股关节负荷过度的活动会使疼痛加重.物理检查见Q角增大(＞20°)45膝,髌软骨外侧小面抠触痛50膝,外侧支持带压痛39膝,被动髌骨倾斜试验阳性51膝,内外侧滑动试验阳性49膝,压髌试验阳性51膝.X线检查轴位片见髌股对合角异常32膝.术中在关节镜监视下,用射频汽化钩刀松解外侧支持带,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.结果术后所有病例均得到随访,平均随访14.5个月(3～26个月).疗效评定参照改良Lysholm评分标准,优37膝,良12膝,可2膝.Lysholm评分从术前平均(62.04±5.98)分(49～75分)提高到术后平均(93.71±3.55)分(86～100分),有显著性差异(t=6.63,P＜0.001).髌股对合角异常的32膝中术后有30膝髌股对合角恢复正常(94%).术后5膝有血肿形成(10%).结论关节镜下外侧支持带松解是一种微创的软组织平衡手术,能够有效地缓解髌骨外侧高压综合征引起的髌股关节疼痛,且并发症较少.

Treatment for lateral patellar compression syndrome with arthroscopic lateral retinacular release

Objective:To explore the practical significance and effects of arthroscopic lateral retinacular release in the treatment of symptomatic lateral patellar compression syndrome.Methods:Thirty-nine patients (fifty-one knees) with lateral patellar compression syndrome underwent arthroscopic lateral retinacular release.The patients were comprised of one man (one knee) and thirty-eight women (fifty knees).One knee was affected in twenty-seven patients,and double knees in twelve patients.Mean age 49.6 years (ranging from twenty-eight to seventy-one years).The clinical symptoms were characteristically dull pain,poorly localized,and increased by activities that overload the patellofemoral joint.In physical examination,we found Q angle increased (>20°) in forty-five knees,the lateral patella facet was tender in fifty knees,the lateral retinaculum was tender in thirty-nine knees,passive patellar tilt test positive in fifty-one knees,medial and lateral glide test positive in forty-nine knees,patellar compression test positive in fifty-one knees.Using axial views we found the congruence angle abnormal in thirty-two knees.Under arthroscopic guidance the lateral retinaculum was released with radiofrequency vaporization,if it is required,we enlarged the range of releasing proximally toward the vastus lateralis for complete releasing.Results:All the patients were available at following-up,the mean following-up was 14.5 months (ranging from three to twenty-six months).The results were evaluated according to the modified Lysholm scoring system,exellent in thirty-seven knees,good in twelve knees and fair in two knees.The mean preoperative Lysholm score increased from 62.04 (ranging from forty-nine to seventy-five) to 93.71 (range eighty-six to one hundred) postoperatively,the difference was statistically significant (t=6.63,P<0.001).Preoperative and postoperative congruence angles were compared on the tangential patella roentgenograms,the congruence angle recoverd to normal postoperatively in thirty-two knees (94%).Five knees developed hemarthrosis postoperatively (10%).Conclusion:Arthroscopic lateral release is a soft-tissue balancing technique and may provide a successful outcome with a low incidence of complication when used to treat patellofemoral pain due to lateral patellar compression syndrome.