关节镜手术治疗髌骨脱位17例疗效分析

Arthroscopic surgery for patellar subluxation:surgical outcome of 17 cases

目的介绍髌骨脱位的关节镜下微创手术技术及疗效。方法2004年1月至2007年6月应用关节镜技术对17例髌骨脱位患者进行了手术治疗，技术要点为关节镜下髌外侧支持带松解，内侧支持带紧缩缝合，其中2例同时行胫骨结节内移抬高术。患者年龄10～28（1．5±4．9）岁，病程7～50（23．1±13．0）个月，随访时间6～24（18，0±6．2）个月。手术前后采用Lysholm评分对膝关节功能进行评定。结果有2例患者失访，患者无1例复发脱位。手术前Lysholm评分为78～90（86．6±4．4）分，手术后提高至90～98（92．9±3．3）分。经过Student-t检验分析，手术前后Lysholm评分有非常显著性差异（t=5．63，P〈0．01）。结论关节镜技术既显示了微创优势，同时又对不同程度的髌骨脱位皆获得了满意治疗效果。

Objective To introduce arthroscopic technique in managing patellar subluxation and its clinical results. Methods Between Jan. 2004 and Jun. 2007, 17 patients suffered from patellar subluxation underwent arthroscopic surgery in Xijing Hospital. The key points of our technique are lateral retinaculum release and medial retinaculum shrinking suture. Tibial tuberosity was translated medially and elevated in 2 patients by osteotomy. The average age of all patients was （21.5±4.9） years （range 10 to 28）. The patients suffering from patellar subluxation averaged （23.1±13.0） months （ range 7 to 50） before operation. They were followed up for average （18.0±6, 2） months （range 6 to 24）. The Lysholm score before and after operation was compared in all patients. Results Fifteen of total 17 patients were followed up, and no recurrence was found. Lysholm score of 17 patients was significantly higher after operation than that before operation （t =5.63, P 〈 0.01 ）. Conclusion Arthroscopic surgery for patellar subluxation achieves excellent outcomes through minimum invasion.