关节镜下外侧支持带囊外松解合并内侧髌股韧带双束重建术治疗急性和复发性髌骨脱位

Arthroscopic treatment for acute and recurrent patellar dislocation with lateral retinacular release outside the synovial bursa combined with dual-bundle reconstruction of medial patellofemoral ligament

目的 探讨关节镜下外侧支持带囊外松解合并内侧髌股韧带双束重建治疗急性和复发性髌骨脱位患者的疗效.方法 对38例（38膝）髌骨脱位患者于关节镜下行外侧支持带囊外松解,并游离自体半腱肌肌腱,双束重建内侧髌股韧带.10例合并髌骨骨软骨骨折的患者同时行切开骨软骨块复位可吸收棒内固定.随访24个月.采用影像学检查评价髌股适合角、髌骨倾斜角改善状况,采用Lysholm膝关节功能评分评定膝关节功能.结果 本组患者手术后恐惧试验均为阴性,随访期间未见明显关节僵硬、疼痛等不适,髌骨无再次脱位发生;末次随访时髌股适合角及髌骨倾斜角均较手术前显著缩小,Lysholm膝关节功能评分较手术前显著提高（P〈0.01）,10例髌骨骨软骨骨折患者均获得骨性愈合.结论 关节镜下外侧支持带囊外松解并合内侧髌股韧带双束重建治疗急性和复发性髌骨脱位患者可取得良好的效果.

Objective To investigate the effect of lateral retinacular release outside the synovial bursa com- bined with dual-bundle reconstruction of medial patellofemoral ligament （MPFL） for acute and recurrent patellar dislocation under arthroscopy. Methods 38 patients （38 knees） with patellar dislocation underwent lateral retinacular release outside the synovial bursa under arthroscopy, the semitendinosus was freed, followed by dual-bundle reconstruction of medial patellofemoral ligament. 10 patients who had osteochondral fracture of the patella underwent open reduction and bioabsorbable pins internal fixation. The follow-up was 24months. The improvement of patella-femoral fit angle and patellar tilt angle was evalua- ted with imaging examination, and the knee function was evaluated with Lysholm scores. Results For all patients, the fear test was negative after operation~ during follow-up, ankylosis and ache were not noticed, there was no redislocation and fracture of the patella; at the final follow-up, reduced fit angle and tilt angle as well as improved Lysholm scores were noticed （P〈0.01）. Conclusion Using lateral retinacular release outside the synovial bursa combined with dual-bundle reconstruction of medial patellofemoral ligament can achieve good therapeutic effect for acute and recurrent patellar dislocation.