关节镜在创伤性髌骨脱位诊治中的临床价值探讨

目的 探讨关节镜在创伤性髌骨脱位诊治中的价值.方法 2009年4月至2013年3月昆明市中医医院收治并获得良好随访的创伤性髌骨脱位患者31例,男性9例,女性22例,平均年龄（17±3.4）岁,均有明确的膝关节扭伤史,手术先行关节镜探查,再在髌内侧做小切口行髌内侧支持带缝合修补,术后指导功能锻炼,平均随访时间6～24个月,观察膝关节功能恢复情况,比较术前及术后Lysholm评分的差异,评定疗效.结果 Lysholm评分从术前的（56.6±6.3）分提高至（96.4±5.2）分（P＜0.01）,术中关节镜探查明确31例患者的髌内侧支持带均有不同程度撕裂,髌骨内下缘及股骨外髁均有骨软骨挫伤,其中有15例患者髌骨内下缘骨软骨骨折并形成游离体.结论 关节镜辅助内侧小切口修复髌内侧支持带治疗创伤性髌骨脱位具有良好疗效;关节镜探查不仅能明确髌内侧支持带撕裂范围,而且能探查处理骨软骨骨折,防止因游离体造成的创伤性关节炎发生;关节镜在诊断和治疗创伤性髌骨脱位中具有实用而重要的临床价值.

Value of Arthroscopy in the Diagnosis and Treatment of Traumatic Patella Dislocation

Objective To explore the value of arthroscopy in the diagnosis and treatment of traumatic patella dislocation.Method We retrospectively analyzed the data of 31 patients with traumatic patellar dislocation admitted to our hospital during 2009-2013,including 9 males and 22 females with mean age of （17 ± 3.4） years.All patients had a clear history of knee sprains and a good follow-up.Arthroscopy was used to explore articular injury at the initial outset of the procedure,and then sutured medial patellar retinaculum through a small incision.The average follow-up time was 6-24 months,and knee function recovering was observed.The differences of preoperative and postoperative Lysholm scores were compared.Results Lysholm score was improved from 56.6 ± 6.3 preoperatively to 96.4 ± 5.2 （P＜ 0.01）.All patients＇ retinaculum had varying degree tear,and the lower edge of the patella and femoral condyle had contusion,of which 15 patients had osteochondral fracture of the lower edge of the patella and formed loose body.Conclusion Arthroscopy assisted small incision has good effect on treating traumatic patellar dislocation.Arthroscopy can not only clear the tear range,but also probe handle osteochondral fracture and prevent traumatic arthritis caused by loose body.Arthroscopy has a practical and important clinical value in the diagnosis and treatment of traumatic patellar dislocation.