关节镜下治疗髌骨不稳定的疗效分析

The clinical effect analysis of arthroscopic therapy for patellar instability

目的 对比分析改良Maquet三联手术与关节镜辅助下自体腘绳肌腱重建内侧髌股韧带治疗髌骨不稳定的临床疗效. 方法 对2009年1月—2012年12月因髌骨不稳定住院治疗的患者90例,实验组采取关节镜辅助下自体腘绳肌腱重建内侧髌股韧带治疗, 对照组采取改良Maquet三联手术治疗,采取回顾性分析法,对比分析两组患者手术前后外侧髌股角、髌骨适合角及髌骨外移程度. 术后随访12个月,对比两组患者的Lysholm评分（Lysholm knee score scale, LKSS）和Kujala评分,并复查两组患者的膝关节正侧位及屈膝60° X线平片.结果 两组术后的外侧髌骨角均显著大于术前,髌骨适合角及髌骨外移程度均显著小于术前,P〈0.01;且实验组的外侧髌骨角、髌骨适合角和髌骨外移程度改善优于对照组,P〈0.01. 术后12个月两项的Lysholm评分和Kujala评分均显著高于术前,P〈0.01,且实验组术后12个月的两组评分均显著高于对照组,P〈0.01.结论 关节镜辅助下自体腘绳肌腱重建内侧髌股韧带治疗髌骨不稳定相比传统开放性手术,可取得较好的术后疗效,同时有效防止术后复发,值得临床进一步推广.

Objective To compare and analyze the clinical efficacy for patellar instability of modified Maquet triple and econstructing medial patellofemoral ligament with hamstring tendon autografts assisted by arthroscopic surgery. Methods A retrospective analysis was held in our hospital. We selected 90 hospitalized patients of patellar instability from January 2009 to December 2012. Patients in the experimental group took the arthroscopic assisted econstructing medial patellofemoral ligament with hamstring tendon autografts. While patients in the control group took the improved Maquet triple. We compared lateral patellofemoral angle, patella and patellar suitable degree angle outward of two groups of patients before and after the operation. While for all patients after a 12 months follow-up, we compared Lysholm score （Lysholm knee score scale, LKSS） and Kujala score of two groups of patients. We also reviewed knee and lateral flexion 60° X-ray film in the two groups of patients. Results Postoperative lateral patellar angle was significantly greater than that before surgery, while patella and patellar degree angle suitable for relocation were significantly less than those before operation, P〈0.01. Lateral patellar angle, the patella and patellar suitable degree angle outward in the experimental group were much improved than those of the control group, P 〈0.01. The Lysholm score and Kujala scores after the surgery were significantly higher than those before surgery, P〈0.01, and two scores in the experimental group after 12 months were significantly higher, P 〈0.01. Conclusion The arthroscopic assisted econstructing medial patellofemoral ligament with hamstring tendon autografts reconstruction has a better curative effect in the treatment of patellar instability compared with traditional open operation. It can also effectively prevent recurrence, which is worthy of further promotion.