关节镜下髌骨成形及髌周去神经化治疗髌股关节炎

Arthroscopic patelloplasty and circumpatellar denervation for the treatment of patellofemoral osteoarthritis

目的：探讨关节镜下髌骨成形及髌周去神经化治疗髌股关节炎的手术方法和临床疗效。方法 ：自2011年9月至2013年3月收治髌股关节炎患者156例,其中男62例,女94例;年龄45~61岁,平均52岁。临床表现为膝关节反复肿胀、疼痛,上下楼、蹲下起立时疼痛加重。采用关节镜下髌骨成形及髌周去神经化治疗。手术前后采用Lysholm评分及Kujala评分对疗效进行评估,并将软骨损伤程度进行分级后评估疗效。结果：术后149例获得随访,时间10~18个月,平均（14.8±3.5）个月,切口均愈合良好,未见并发症。Lysholm评分由术前73.29±4.48提高到术后80.93±4.21,Kajala评分由术前68.34±6.22提高到术后76.48±6.54,软骨损伤Ⅰ-Ⅲ级者术后疗效较好,软骨损伤Ⅳ级者疗效较差。结论：关节镜下髌骨成形及髌周去神经化治疗髌股关节炎可明显缓解膝前疼痛,改善膝关节功能,提高生活质量,延缓关节炎进程。

Objective：To investigate surgical procedure and clinical effects for the treatment of patellofemoral osteoarthritis（PFOA） with arthroscopic patelloplasty and circumpatellar denervation. Methods：Totally 156 patients with PFOA（62males and 94 females; aged from 45 to 61 years old with an average of 52） were treated from September 2011 and March 2013.The clinical manifestations included recurrent swelling and pains on knee joint,and aggravated pains upon going up / down stairs,squatting down,or standing up. PFOAs were treated with arthroscopic patelloplasty and circumpatellar denervation. The therapeutic effects before and after surgery were evaluated by Lysholm scores and Kujala scores. The therapeutic effects were graded by classification of cartilage injury degrees. Results：Totally 149 cases were successfully followed up for 14.8 months.The incisions were healed well and no complication were occurred. Lysholm score was improved from 73.29 preoperatively to80.93 postoperatively,and average Kajala score from 68.34 preoperatively to 76.48 after surgery. This procedure was highly effective for patients withⅠ-Ⅲ degree cartilage injury,while not for patients with Ⅳ degree cartilage injury. Conclusion：For PFOA patients,arthroscopic patelloplasty and circumpatellar denervation is effective for significantly relieving anterior knee pains,improving knee joint functions and quality of life,and deferring arthritic procession.