关节镜下外侧支持带囊外松解结合髌股内侧支持带重建治疗复发性髌骨脱位

Analysis of effects of arthroscopic treatment for recurrent patellar dislocation by lateral patellar retinacular release outside the synovial bursa of knee joint combined with reconstruction of medial patellofemoral ligament

目的 ：介绍复发性髌骨脱位的关节镜下微创手术技术及疗效。方法 ：复发性髌骨脱位16例,男3例,女13例;年龄14~32岁,平均17.6岁;病程6~23个月,平均18.5个月。关节镜下髌股外侧支持带囊外松解,自体股薄肌腱游离移植重建髌股内侧支持带重建,手术前后根据Lysholm评分评价疗效。结果：全部患者获随访,时间6~48个月,平均12个月。患者的Q角由术前的（16.4±3.7）°减小至重建后6个月的（10.1±1.4）°,Insall指数由术前的1.37±0.25减小至重建后6个月的1.28±0.23,适配角由术前的（21.3±2.6）°减小至重建后6个月的（5.86±2.23）°,Lysholm评分由术前的76.1±5.2提高至重建后6个月的89.8±4.1。结论：关节镜下外侧支持带囊外松解结合髌股内侧支持带重建治疗复发性髌骨脱位可减少出血及术后瘢痕粘连,创伤小,有利于患者术后功能康复。

Objective：To introduce an arthroscopic technique in managing recurrent dislocation of the patella and its clinical results. Methods：Sixteen patients with recurrent patellar dislocation were reviewed, including 3 males and 13 females. The average age was 17.6 years old （ranged from 14 to 32 years）. The patients suffering from patellar sub-luxation averaged 18.5 months （ranged from 6 to 23 months）before operation. These patients were treated with lateral patellar retinacular release outside the synovial bursa of knee joint and medial patellofemoral ligament reconstruction using the semitendinosus tendon free autograft. The Lysholm scores before and after operation were used to evaluate outcomes at the final follow-up. Results： Al1 the patients were followed up, and the duration ranged from 6 to 48 months, with an average of 12 months. There was no recurrence. The Q angle decreased from（16.4±3.7）° to （10.1±1.4）° ;insall index decreased from 1.37±0.25 to 1.28±0.23 ;congruence an- gle decreased from（21.3±2.6）° to （5.86±2.23）° ;Lysholm score improved from 76.1±5.2 to 89.8±4.1 at 6 months after opera- tion. Conclusion ： Compared with conventional procedure, arthroscopic surgery for recurrent dislocation of the patella achieves excellent outcomes with minimum invasion.