关节镜下外侧松解治疗髌股关节紊乱症

Arthroscopic Relief of Patello-femoral Joint Disorders

报告经关节镜行膝关节髌骨外侧支持带松解术治疗25例30膝髌股关节紊乱。其中有17例21膝术前经CT扫描显示有髌股排列异常（髌骨外倾，半脱位）。手术是在关节镜视下将髌骨外侧支持带切断松解。术后随访平均13．3个月，优11膝，良10膝，可5膝，差4膝，优良率达70％。结论：（1）外侧支持带紧张可导致髌股关节排列异常，产生症状，CT扫描可精确测量髌骨与股骨髁间凹的位置关系。（2）关节镜下可见髌股关节排列异常及关节软骨受损程度、范围及关节内其他病变，同时可进行外侧松解和其他必要的治疗，但关节退变程度明显影响疗效。本法创伤小，不妨碍以后进一步手术。

Intra-arthroscopic division of lateral retinaculum of knee to treat of patellofemoral disorders in 30 knees of 25 cases was reported. Among them, 21 knees of 17 cases were scanned by CT pre-operatively, images showed some patellofemoral malalignment (patellar tilt and subluxation). In an av-erage follow-up of 13. 3 months, 70% of operated knees resulted satisfactory (Excellent 11 knees；Good 10 knees； Fair 5 knees； Poor 4 knees). Conclusion: (1) A tight lateral retinaculum resulting inthe patellofemoral malalignment is responsible for the clinical syndrome. Computed tomographic evalu-ation of patellofemoral malalignment is a far better diagnostic technique. (2) A complete intra-articularexamination might be achieved under arthroscopy. Patellofemoral malalignment after accompanied withvarious extent of articular cartilage damage and other lesions to be treated accordingly. The unsatisfac-tory results were much related to the articular degenerative changes which were already present. Thisarthroscopic approach was simple with little trauma and it would not hinder further procedures if neces-sary.