关节镜下外侧支持带松解和内侧紧缩并髌韧带止点移位治疗复发性髌骨脱位

Lateral retinacular release and articular capsule striction retinaculum and patellae displacement using arthroscope for recurrent dislocation of the patella

目的探讨关节镜下外侧支持带松解和内侧关节囊紧缩并髌韧带止点移位治疗复发性髌骨脱位。方法复发性髌骨脱位28例。关节镜下探查,软骨修整、钻孔,游离体摘除,外侧支持带充分松解后,采用双固定螺钉加强并紧缩内侧关节囊,同时将髌韧带止点内侧移位并固定,关节镜下观察髌骨运动轨迹,观察股骨滑车与髌骨的对应关系。结果所有患者术后均获随访,随访12～34个月,平均17个月。术后膝关节稳定性增加,无髌骨再脱位发生。恐惧试验阴性,髌骨倾斜试验对称,髌股关节研磨试验阴性26例,阳性2例。髌骨轴位X线片和MRI显示髌股关节解剖关系恢复正常26例,髌骨轻度半脱位2例。术前Lysholm评分平均(73.8±4.5)分,术后(92.4±2.8)分。结论关节镜下外侧支持带松解和内侧关节囊紧缩并髌韧带止点移位治疗复发性髌骨脱位,具有创伤小、恢复快、复发率低、效果可靠等优点,同时,双固定螺钉固定修复术操作简单,切口小,术后可最大限度恢复功能。对于维持髌骨的运动轨迹具有重要作用。

[Objective] To investigate the outcomes of lateral retinacular release and articular capsule striction retinaculum and patellae displacement using arthroscope for the treatment of recurrent dislocation of the patella.[Methods] 28 cases of recurrent dislocation of the patella were included in this group,among which there were 10 males and 18 females.Arthroscopic investigation found tensed lateral retinaculum patellae and damaged cartilage at patellar medial margin and femoral lateral condyle.Agangland the lateral retinaculum patellae was extensively released,double-fixed screw was used to reconstruct the medial patellofemoral ligament.The knee joint was flexed and extended.Patella＇s dynamic motion,the tension of the tendon and relationship between the femoral trochlea and patellar bone were arthroscopically observed.[Results] All patients were followed up for 12 to 34 months averaging 17months.No patellar dislocation occurred postoperatively.Apprehensive test,patella tilt test were negative;and Apley test were negative in 26 patients and positive in 2 patients.Axial view of X-ray and MR images of patella showed 26 cases regained normal anatomical relation of patellofemoral joint.2 cases had mild semi-dislocation.Lysholm＇s score averaging（73.8±4.5） points preoperatively and（92.4±2.8） points postoperatively.[Conclusions] Lateral retinaculum patellae solution and medial patellofemor al ligament reconstruction using the semitendinosus tendon free grafted fixed by double-fixed screw for the treatment of recurrent dislocation of the patella not only can effectively cure recurrent subluxation of the patella and improve knee joint function but can make the patients smaller wound,quicker recovered,lower recurrence rate and more reliable effective.