关节镜辅助下小切口微创治疗急性髌骨脱位

目的探讨关节镜辅助下小切口微创治疗急性髌骨脱位的方法和疗效。方法 2008年7月至2011年9月,我科收治急性髌骨脱位14例,男9例,女5例;年龄16~28岁,平均(21.8±5.3)岁。患者入选条件:所有患者均有明确膝关节暴力外伤史,排除关节松弛和髌股关节发育异常。从发生髌骨脱位到手术的时间间隔为3~14 d,平均5.6 d。术中先行关节镜检查并清理关节腔内积血和处理关节软骨损伤后,在髌骨内侧做1个1.5 cm长纵行小切口,通过上下推移皮肤,在髌骨中上部拧入带线锚钉,使用过线方法折叠缝合髌内侧支持带,视髌骨复位情况行外侧支持带松解。结果 14例患者获得随访,术后随访24~60个月,平均36.1个月。全部病例未再次发生脱位,恐惧试验全部阴性。关节活动度均在正常范围,3例关节早期过屈时有轻度紧张感,随访患者均恢复伤前的生活状态。所有病例均未出现重度髌股关节退行性改变。结论关节镜辅助下小切口治疗急性髌骨脱位安全、可行,疗效显著。

Arthroscopically Minimally Invasive Treatment of Acute Patellar Dislocation

Objective To explore the clinical methods and effects of arthroscopically minimally invasive treatment of acute patellar dislocation.Methods From July 2008 to September 2011,14 patients with acute patellar dislocation were treated,including 9 males and 5 females with an average age of（21.8 ± 5.3） years.All had history of knee trauma,without knee laxity and dysplasia of patellofemoral joint.All the patients experienced arthroscopic examination first and removed of hemarthrosis and treat of injured artificial surface.Then through a 1.5 cm incision at median rim of patella,pushing the skin,anchor fixation method was applied to fold medial retinaculum for reconstruction.Lateral patellofemoral ligament would be released depended on the conditions.Results 14 patients were followed up postoperatively from 24 - 60 months with an average of 72.2months.The patients had no recurrence of dislocation after operation,the apprehensive tests were negative and their ranges of motion returned to normal.3 of them got a slight feeling of stress when the knee was overflexed but all resumed the pretrauma life state.The structures of patellofemoral joint were normal and the areas of injured cartilage got neither enlarged nor further degenerated on radiographs and MRI.Conclusion Arthroscopically minimally invasive treatment of acute patellar dislocation is an easily operation and has a number of benefits.Its clinical outcome is reliable.