急性髌骨脱位的关节镜下诊断与治疗

目的 探讨急性髌骨脱位的关节镜下表现,评价关节镜下治疗方法对其的疗效.方法 2001年2月至2003年12月,共收治急性髌骨脱位16例17膝,女12例,男4例,1例女性患者为双侧发病.年龄14～31岁,平均21.9岁.从发生髌骨脱位到手术的时间间隔为3～25 d,平均13.6 d.术前对所有患者进行放射学检查,观察髌骨的形态和位置、股骨滑车角、髌骨外侧半脱位和下肢对线的状况.临床测量Q角和全身关节松弛度.全部手术均在关节镜监视下施行.首先引流关节内血肿,而后进行全面的关节内探查,取出游离的软骨和骨软骨碎片,施行软骨成形术,修整损伤的软骨面,最后松解外侧支持带以及紧缩缝合内侧支持带.结果 关节镜下表现包括关节内血肿,股骨外侧髁和髌骨内侧骨软骨损伤,游离体形成以及内侧支持结构撕裂.所有病例均获得随访,随访时间1.5～3.5年,平均2.1年,均未发生感染等严重并发症,也无关节内大量血肿和髌骨缺血性坏死发生.全部病例膝关节活动度恢复正常,恢复至术前的活动水平,未发生再脱位.5例患者术后早期主诉髌骨内侧存在牵拉感和弹响.所有病例均未出现重度髌股关节退行性改变.结论 关节镜手术是诊断和治疗急性髌骨脱位的优良方法,操作简便,疗效可靠.

Arthroscopic diagnosis and treatment of acute dislocation of the patella

Objective To review operative findings and clinical results of arthroscopic treatment of acute dislocation of the patella. Methods From February 2001 to December 2003, 16 patients(17 knees) with primary acute complete dislocation of the patella had undergone arthroscopic operations, including 4 males and 12 females with an average age of 21.9 years(range, 14 to 31 years). One patient had bilateral procedure. 8 left knees and 9 right knees were involved. The average period after the dislocation to surgery was 13.6 d(range, 3 to 25 d). Before operation, radiograph was used to determine the shape and the height of patella, the angle of the femoral sulcus, lateral shift of patella and the axis of limb in each knee. Clinically, Q angle and generalized joint laxity were measured. The surgical technique consisted of drainage of haemarthrosis, removel of loose body, treatment of concurrent osteochondral injury, release of lateral retinaculum and suture of medial capsule and retinaculum structure with arthroscopy assistance. Results Constant findings under arthroscopy were haemarthrosis, osteochondral fragments, tear of the medical retinaculum and chondral lesions involved in the lateral femoral condyle and medial marginal of patella. All the patients were available at follow-up; the average duration of follow-up was 2.1 years (ranged from 1.5-3.5 years). There were no any signs of serious complication, such as infectious complication, after operations in all patients. Neither any more extensive bleeding nor avascular necrosis of patella was encounted. There were no recurrences of dislocation after the surgery. There were no significant differences in sporting activities between before injury and during follow-up. 5 patients had transient discomfort and sensation of snapping during follow-up. No case was in connection with severe degenerative damage of the patellofemoral joint. Conclusion The diagnosis and treatment of acute dislocation of the patella under arthroscopy assistance is an easily feasible operation and has a number of benefits. Its clinical outcome is reliable.