髌骨半脱位70例治疗分析

The Clinic Analysis of the Treatment of Patellar Subluxation

目的探讨髌骨半脱位的治疗方法及其预后。方法回顾性分析70例（130膝）髌骨半脱位患者的临床资料，其中男30例，女40例；年龄10～48岁，平均23岁。患者髌骨的形态均为WibergⅡ、Ⅲ型，其中伴有外侧髌股关节骨关节炎者58例108膝，高位髌骨23例46膝，外伤后股四头肌内侧头肌张力不良10例10膝。Q角20°～40°。全部行手术治疗，手术方式包括：髌外侧支持带充分松解（130膝）；髌内侧支持带紧缩、股内侧肌移位至髌骨前内侧（12膝）；髌骨外侧部分切除（17膝）；胫骨结节前、内侧移位（46膝），平均内移1．0cm、前移1．2cm；缝匠肌前移（11膝），半腱肌前移（13膝）；关节镜下髌外侧支持带松解，髌内侧支持带紧缩（31膝）。术中见全部病例髌外侧支持带均明显增厚。结果随访3～180个月，根据Insall等评分系统评估分析疗效，术后疗效优78膝，良33膝，可12膝，差7膝。患者术后疼痛、关节活动功能均得到明显改善，尤其是解除膝前痛效果显著。结论根据病因及病理改变选择恰当的手术方式治疗髌骨半脱位均可取得满意的效果，特别是关节镜手术具有创伤小、恢复快的特点，值得进一步推广应用。

Abstract：Objective To study the treatment and prognosis of patellar subluxation. Methods Clinical data of 70 patients（130 knees） with patellar subluxation were analyzed retrospectively. 30 patients were male and 40 patients were female,age ranged from 10-48（mean 23）. The shapes of patella were both type Ⅱ and Ⅲ of Wiberg shapes. There were 58 cases （108 knees）with lateral patellofemoral arthritis, 23 cases （46 knees）with patella alta and 10 cases （10 knees）with insufficient of vastus medialis obliques muscle function. The Q angle ranged from 20 to 40 degrees ,all cases were treated by operation. The methods of the operations involved lateral patellar retinaculum release for 130 knees;medial patellar retinaculum reefing and vastus medialis obliques muscle transfer for 12 knees;partial lateral facetectomy for 17 knees ;anteromedial moving of the tibial tubercle for 46 knees（mean medial moving for 1.0 cm and anterior moving for 1.2 cm）;anterior moving of sartorius muscle for 11 knees ;anterior moving of semitendinosus for 13 knees;Arthroscopic treatment of patellar subluxation by lateral patellar retinaculum release and medial patellar retinaculum reefing for 31 knees ;Thickening and tightness of the lateral patellar retinaculum could be observed during operation. Results All patients were followed up for 3-180 months,and to assess outcome by Using Insall score system. Effect after 78 knees were excellent ,good in 33 knees, 12 knees can be ,poor in 7 knees, the pain and the function of knee were obviously improved ,especially the pain of knee. Conclusion We will obtain satisfying outcome by selecting appropriate modus operandi to treat patellar subluxation, especially,it is less invasive and fast recovery with arthroscopy to treat patellar subluxation,it is worthy to be spreaded further.