综合手术方案治疗复发性髌骨脱位的疗效观察

Evaluation of the compound operative treatments of recurrent patellar dislocations

目的评价采用关节镜下外侧松解、内侧支持带紧缩缝合、半髌腱移位术的综合手术方案治疗复发性髌骨脱位的临床疗效。方法以1998～2004年收治的38例患者为研究对象，男17例，女21例。29例有明确外伤史，不包括髌骨完全性脱位且关节活动时髌骨始终不与股骨髁问构成关节面关系的病例。通过了解病史、体查以及CT或MRI资料分析确定髌骨脱位病因。关节镜下外侧支持带松解与内侧支持带紧缩缝合、髌腱外1／2连同外侧胫骨结节止点向内侧交叉移位。术后不制动，髌骨行保护性的康复疗程。术后3个月以及每年随访，检查髌骨轨迹、关节活动度以及行髌骨切线位片或CT检查。结果29例患者获3—60个月（平均40．2个月）随访，均无脱位复发，恐惧感消失，物理及影像学检查表明髌骨稳定。按Lysholm评分评价膝关节功能，29患者术后平均评分为（91．3±3．8）分，较术前的（58．1±5．4）分明显提高，差异有统计学意义（P〈0．01）。结论关节镜下外侧松解、内侧支持带紧缩缝合、半髌腱移位术的综合手术方案治疗复发性髌骨脱位疗效确切，操作简便，易于掌握。

Objective To evaluate the therapeutic effects of compound operative treatments （arthroscopic lateral retinacular release, medial retinacular tightening plus medial transfer of semi-tibial tuberosity） for recurrent patellar dislocations. Methods From 1998 to 2004, 38 patients with recurrent patellar dislocation, aged from 14 to 28 years, were treated with arthroscopic lateral retinacular release, medial retinacular tightening plus medial transfer of semi-tibial tuberosity. They were 17 males and 21 females. Twenty-nine of them had a definite history of trauma. Their causes of dislocation were determined by analyzing their medical history, physical check-up and CT or MRI findings. Immobilization was not clone for them and their patellas were rehabilitated in a protective manner. Follow-ups were performed 3 months and every year postoperatively to observe the patellar radiographs and the articular range of motion. Results Twenty-nine patients were followed up for 3 to 60 months, averaging 40. 2 months. No dislocation recurred. Physical and CT examinations displayed stable patellas. The apprehension of patients disappeared. By Lysholm evaluation system, the mean postoperative scores（91.3 ± 3.8） were significantly higher than the preoperative ones （58. 1 ± 5.4） （ P 〈 0. 01 ）. Conclusion The compound operative treatments of recurrent patellar dislocations with arthroscopic lateral retinacular release, medial retinacular tightening plus medial transfer of semi-tibial tuberosity are not difficult but can result in definitely positive effects on recurrent patellar instability.