关节镜下松解联合韧带重建术治疗复发性髌骨脱位的效果分析

Effect analysis of ligament arthrolysis combined with reconstruction in treatment of recurrent dislocation of patella under arthroscopy

目的通过探讨远端重排术和松解联合韧带重建术治疗复发性髌骨脱位的效果,为关节镜下松解联合韧带重建术治疗复发性髌骨脱位的广泛应用提供一定的科学依据。方法笔者自2014-01—2016-01分别采用远端重排术(远端重排组)及松解联合韧带重建术(松解联合韧带重建组)治疗50例复发性髌骨脱位。采用Lysholm和HSS评分评价2组手术前后膝关节功能。2组在术后1、3、6、12个月进行髌骨倾斜试验、髌骨恐惧试验、脱位次数等专项检查,并统计阳性例数。结果 2组获得随访12个月。2组术前Lysholm和HSS评分、髌骨倾斜试验阳性率、髌骨恐惧试验阳性率、脱位次数比较差异均无统计学意义(P>0.05)。松解联合韧带重建组术后1、3、6、12个月Lysholm评分高于远端重排组,差异有统计学意义(P<0.05);松解联合韧带重建组术后1、3、6、12个月HSS评分高于远端重排组,差异有统计学意义(P<0.05);术后1、3个月松解联合韧带重建组髌骨恐惧试验阳性率明显低于远端重排组,差异有统计学意义(P<0.05)。结论关节镜下松解联合韧带重建术治疗复发性髌骨脱位较远端重排术疗效更佳,值得临床推广。

Objective To explore the effect of distal rearrangement and ligament arthrolysis combined with reconstruction in treatment of recurrent dislocation of the patella to provide certain reference basis for the clinical usage of ligament arthrolysis combined with reconstruction. Methods The distal rearrangement （distal rearrangement group） and ligament arthrolysis combined with reconstruction（ligament artbrolysis combined with reconstruction group） were used to treat 50 cases of recurrent dislocation of the patella respectively from January 2014 to January 2016. The Lysholm and HSS scores were used to evaluate knee joint function before and after surgery in 2 groups. The patella separately extrapolate experiment, fear experiment and number of dislocation were examined and number of positive cases was counted 1, 3, 6, 12 months after surgery. Results The two groups were followed up for 12 months. Between two groups, there were no statistically significant differences in preoperative Lysholm, HSS evaluation and the positive rate of patella separately extrapolate experiment, fear experiment and number of dislocation（P 〉0.05）. Lysholm score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group （P 〈0.05）. HSS score in the ligament arthrolysis combined with reconstruction group was higher than the distal rearrangement group（P 〈0.05）. There were no significant differences between the two groups in the positive rate of patella separately extrapolate experiment and number of dislocation of the patella at 1, 3, 6, 12 months after surgery （P 〉 0.05）. The positive ratio of fear experiment at 1, 3 months after surgery was lower in the ligament arthrolysis combined with reconstruction group than the distal rearrangement group, the difference was statistically significant （P 〈0.05）. Conclusion Treatment of recurrent dislocation of the patella with combined release of ligament and reconstruction is better than distal rearrangement, and it is worthy of clinical promotion.