关节镜指导下治疗髌骨不稳定的初步探讨

Preliminary study on treating patellar instability guided by arthroscopy

目的：探讨关节镜指导下诊断及治疗髌骨不稳定的手术方法和临床疗效。方法：经临床和关节镜诊断的髌骨不稳定患者32例（34膝），其中髌骨倾斜2例（2膝）、髌骨半脱位26例（27膝）、髌骨脱位4例（5膝），在行膝关节支持带外侧松解、内侧紧缩的基础上，配合股薄肌前移或胫骨结节内移的综合术式治疗。结果：28例获随访5～87（平均36．6）个月，临床评价优良率为92．8％。结论：关节镜下能直观、动态地观察髌股关节对线情况，股薄肌前移术为主的综合术式治疗髌骨不稳定能有效防止复发，效果满意。

Objective To explore the operation method in treating patellar instability guided by arthroscopy and to evaluate its therapeutic effects, Methods Thirty-two patients （34 knees） with patellar instability including 2 patellar tilt （2 knees）, 26 （27 knees） patellar subluxation, and 4 （5 knees） patellar dislocation, diagnosed by clinical and arthroscopical standard, were treated with anterior transfer of the gracilis or medial transfer of the tibial tuberosity based on the lateral retinacular release and medial tightening. Results Twenty-eight patients were followed up for 5 - 87 （ mean 36.6） months. The excellence rates was 92.8%. Conclusion The patellofemoral alignment can be seen directly and dynamically under the arthroscopy. The combinational treatment including anterior transfer of the gracilis in repairing patellar instability can avoid the recurrence effectively and get satisfactory results.