关节镜下射频汽化仪治疗髌股关节紊乱症

APPLICATION OF RADIOFREQUENCY VAPORIZATION IN ARTHROSCOPIC TREATMENT OF PATELLOFEMORAL JOINT DISORDERS

目的探讨关节镜下应用射频汽化仪治疗髌股关节紊乱症的方法与疗效。方法2004年6月-2007年6月,收治86例98膝髌股关节紊乱症患者。男30例34膝,女56例64膝;年龄15～68岁,中位年龄40岁。左膝42例,右膝32例,双膝12例。病程3个月～6年,平均30.5个月。静力性髌骨外侧倾斜28膝,外侧半脱位10膝;动力性髌骨外侧倾斜45膝,外侧半脱位15膝。术前Lysholm膝关节功能评分(57.72±8.86)分。术中采用关节镜下射频汽化仪行外侧支持带松解术或辅以内侧支持带紧缩术,同时对病变软骨行双极射频软骨成形术。结果髌股关节面软骨病变按Outerbridge分级:Ⅰ级18膝,Ⅱ级36膝,Ⅲ级32膝,Ⅳ级12膝。术后患者切口均Ⅰ期愈合,无关节内积血及关节腔感染等并发症发生。75例82膝获随访,随访时间为8～37个月,平均20.6个月。术后1个月患者膝前痛症状明显缓解,关节活动度良好,动力位及静力位髌骨轴位X线片未见髌骨外侧倾斜或半脱位。术后6个月Lysholm评分为(69.95±5.42)分,与术前比较差异有统计学意义(P<0.05)。按照软骨分级进行Lysholm评分,除Ⅳ级与术前比较差异无统计学意义(P>0.05),Ⅰ、Ⅱ、Ⅲ级患膝与术前比较差异均有统计学意义(P<0.05)。结论关节镜下采用射频汽化仪行软组织平衡术和软骨成形术具有操作简便、创伤小、出血少、术后反应轻等优点,是一种治疗髌股关节紊乱症的有效方法。

Objective To explore the treatment of patellofemoral joint disorders with radiofrequency vaporization under arthroscopy. Methods From June 2004 to June 2007, 86 cases of patellofemoral joint disorder （98 knees） were treated by lateral retinacular release or medial retinacular tighten added, and combined with bipolar radiofrequency chondroplasty under arthroscopy. There were 30 males （34 knees） and 56 females （64 knees）, aging 15-68 years （mean 40 years）. The locations were left in 42 cases, right in 32 cases, both sides in 12 cases. The disease course was 3 months to 6 years （mean 30.5 months）. In 98 knees, there were 28 knees of static patellar tilt, 10 knees of static patellar subluxation, 45 knees of dynamic patellar tilt and 15 knees of dynamic patellar subluxation. The Lysholm knee score preoperatively was 57.72 ± 8.86. Results The patellofemoral cartilage abnormality were classified according to the Outerbridge grade （18 knees of grade Ⅰ, 36 knees of grade Ⅱ, 32 knees of grade Ⅲ and 12 knees of grade Ⅳ）. The incisions healed by first intention without complications such as infection or hemarthrosis. Seventy-five cases （82 knees） were followed up 8-37 months （mean 20.6 months）. One month after operation, the patellofemoral joint pain was relieved remarkably, the knee joint activity was good and the radiological outcomes was also satisfactory. Six months after operation, the Lysholm knee score was improved significantly in patients of grades Ⅰ、Ⅱ and Ⅲ （P 〈 0.05）, while there was no significant change in patients of grade Ⅳ （P 〉 0.05）. The postoperative score was 69.95 ± 5.42 （P 〈 0.05）. Conclusion Radiofrequency vaporization chondroplasty and soft tissue balance under arthroscopy are advantageous in terms of easy operation, less injury, slight reaction and have good effect on patellofemoral joint disorders.