关节镜辅助治疗急性髌骨脱位

ARTHROSCOPICALLY ASSISTED TREATMENT FOR ACUTE PATELLAR DISLOCATION

目的探讨关节镜辅助下外侧支持带松解、内侧支持带紧缩治疗急性髌骨脱位的疗效。方法 2006年4月-2009年3月,应用关节镜辅助下改良髌外侧支持带松解、内侧支持带紧缩治疗急性髌骨脱位22例25膝。男5例,女17例;年龄14～34岁,平均23.6岁。均突发于屈膝活动过程中。左侧11膝,右侧14膝。出现症状至入院时间为1～10 d,平均5.9 d。患者均为外侧脱位,其中14例脱位后自行复位,8例入院时仍呈脱位状态,给予手法闭合复位。检查示膝关节脱位恐惧试验均为阳性,被动活动受限,其中15例浮髌试验阳性。结果术后切口均Ⅰ期愈合。22例均获随访,随访时间12～36个月,平均17个月。术后3个月内,12膝出现髌骨内侧皮肤穿刺处凹陷,10膝出现髌骨外侧疼痛,15膝出现髌骨内侧紧绷牵拉感,经理疗康复后均逐渐自行消失或好转。随访期间无复发性髌骨脱位。术后1年膝关节Lysholm评分为(96.6±4.5)分,高于术前的(67.3±5.7)分,差异有统计学意义(t=3.241,P=0.003);疼痛视觉模拟评分(VAS)为(1.8±0.4)分,低于术前的(6.5±0.5)分,差异有统计学意义(t=2.154,P=0.040)。术后1年患膝功能采用Insall评分标准,获优18膝,良5膝,可2膝,优良率92%。结论 关节镜辅助下外侧支持带松解、内侧支持带紧缩治疗急性髌骨脱位,创伤小,恢复快,早期临床疗效满意。

Objective To evaluate an improving operative procedure and the clinical results of arthroscopically assisted treatment for acute patellar dislocation.Methods Between April 2006 and March 2009,22 patients（25 knees） with primary acute complete dislocation of the patella underwent an improving arthroscopic operation,release of lateral retinaculum and suture of medial capsule and retinaculum structure.There were 5 males and 17 females with an average age of 23.6 years（range,14-34 years）.Three patients had bilateral procedure.Eleven left knees and 14 right knees were involved.The disease duration was 1-10 days with an average of 5.9 days.All patients had lateral dislocation;of them,14 patients showed reduction without treatment,and 8 patients showed dislocation at admission and were given close manipulative reduction.The results were positive for apprehension test in all patients with the limitation of passive motion and for Ballottable Patella Sign in 15 cases.Lysholm score,visual analogue scale（VAS） score,and Insall scale were adopted to evaluate the effect.Results All incisions healed by first intention.All the patients were followed up 12-36 months（17 months on average）.During the first 3 months after operation,sunken skin in the puncture point medial to the patella was observed in 12 knees;10 knees suffered pain of the soft tissue lateral to the patella;15 knees felt tense in the soft tissue medial to the patella,however,all these problems disappeared or recovered gradually after rehabilitation and conservative treatment.No recurrence of dislocation was observed during the follow-up.Lysholm score was significantly improved from preoperative 67.3 ± 5.7 to postoperative 96.6 ± 4.5（t=3.241,P=0.003） and VAS score from 6.5 ± 0.5 to 1.8 ± 0.4（t=2.154,P=0.040）.According to Insall scale,the results were excellent in 18 knees,good in 5 knees,and fair in 2 knees at 1 year after operation with an excellent and good rate of 92%.Conclusion The improving procedure of arthroscopically assisted treatment for acute patellar dislocation is a minimally invasive operation and has a number of benefits.Its short-term clinical outcome was satisfactory.