关节镜下改进紧缩髌骨内侧支持带治疗复发性髌骨脱位

Modified arthroscopic medial retinaculum plication in treatment of recurrent patellar dislocation

目的探讨关节镜下改进紧缩髌骨内侧支持带治疗复发性髌骨脱位的疗效。方法我科于2013年7月至2015年7月收治复发性髌骨脱位病人23例,男4例,女19例,年龄为10~25岁,平均为15.8岁。手术在关节镜下操作,用等离子刀常规进行松解髌骨外侧支持带,用ACCU PASS自动连续传递缝合钩将PDS缝线四等分整体跨越髌骨内侧支持带,采用对称集中打结法拉紧缝线,实现对髌骨内侧支持带的有效紧缩。术后鼓励病人在膝关节支具保护下早期进行功能锻炼。比较手术前后Lysholm膝关节评分、Tegner膝关节运动水平评分和髌骨外移度。结果单膝的关节镜下操作时间为40~55 min,平均为46.4 min。术中实现髌股关节面复位,屈膝关节活动(0°~90°)时髌骨活动轨迹满意,病人没有发生再脱位。随访时间为18~36个月,平均为24.6个月。末次随访时病人髌骨位置满意,膝关节静息位或屈伸活动时未发生髌骨再脱位。术后18个月Lysholm膝关节评分为(79.6±5.4)分、Tegner膝关节运动水平评分为(5.4±0.9)分、髌骨外移度为(3.8±1.1)mm与术前的(51.9±7.9)分、(2.8±1.2)分、(11.8±2.1)mm比较,差异均有统计学意义(均P<0.05)。结论关节镜下采用ACCU PASS自动连续传递缝合钩可以方便对髌骨内侧支持带紧缩的操作,PDS缝线行对称集中式打结能获得坚强的固定紧缩效果,本方法具有操作便捷、固定强度好、膝关节功能恢复快、近期疗效好的特点。

Objective To explore the therapeutic effect of modified medial retinaculum plication byACCU PASS suture shuttle and a new knotting technique in the treatment of recurrent patellar dislocation byarthroscopy. Methods There were a total of 23 cases(4 males and 19 females) of patella dislocation from July2013 to July 2015 in our department, and their average age was 15.8 years old(ranging from 10 to 25 years old).All operations were performed by arthroscopy. Firstly, lateral patellar retinaculum was released by plasmasurgery system and medial patellar retinaculum was quartered crossed by ACCU PASS suture shuttle. Secondly,non-absorbable suture was tightened by symmetrical centralized suturing and knotting technique to realizestrong tightening of medial patellar retinaculum. Early rehabilitation trail was given to patients under theprotection of brace. The recurrence of dislocation, Lysholm and Tegner scores were recorded. Results Theaverage arthroscopy operation time of one knee was 46.4 min(ranging from 40 to 55 min). The patella positionwas reset after operation and its track was normal when bowing knee. After follow-up for 18 to 36 months(mean24.6 months), there was no recurrence of dislocation. Lysholm and Tegner scores were tested bothpreoperatively and postoperatively, and lateral shift distance was compared. Statistically, the difference betweenthese two scores was significant(P<0.05). Conclusion The medial retinaculum can be tightened strongly bythe modified medial retinaculum plication by ACCU PASS suture shuttle and a new knotting technique byarthroscopy. This method can be helpful to make an easily feasible operation and has excellent effect of highstrength of fixation and quick recovery of joint function.