小切口延长与关节镜下外侧支持带松解术联合髌股韧带重建术治疗复发性髌骨脱位的早期疗效比较

Lateral retinacular release via a prolonged incision versus arthroscopic lateral retinacular release in osteofascial medial patellofemoral ligament reconstruction for recurrent patellofemoral dislocation

目的比较小切口延长与关节镜下外侧支持带松解术（LRR）联合髌股韧带重建术（MPFL-R）治疗复发性髌骨脱位的早期疗效。方法回顾性分析2012年5月至2015年3月河北医科大学第三医院关节外科治疗的51例复发性髌骨脱位的患者资料，男16例，女35例；年龄20．36岁，平均27．2岁。根据手术方式分为2组：28例患者行小切口延长LRR联合MPFL—R术（切开组），23例患者行关节镜下LRR联合MPFL—R术（镜下组）。通过比较术前、术后髌骨外移率、髌骨倾斜角、滑车沟角和胫骨结节．股骨滑车间距（nTG）来评估影像学改变；末次随访时采用膝关节Kujala评分和Lysholm评分评定功能。结果切开组与镜下组复发性髌骨脱位患者术前一般资料比较差异均无统计学意义（P〉0．05），具有可比性。51例患者术后获10。32个月（平均20个月）随访。术后切开组与镜下组再脱位率分别为0和8．7％（2／23）；两组均未出现髌骨骨折、下肢深静脉血栓形成和关节伸屈受限等并发症；末次随访时两组均未出现髌骨再脱位患者。切开组术前髌骨外移率、髌骨倾斜角、Kujala评分、Lysholm评分分别为19．65％±0．75％、12．39°±0．76°、（56．37±2．94）分、（51．64±6．22）分，术后分别为10．34％±0．60％、8．83°±0．89°、（92．68±2．75）分、（90．71±1．91）分；镜下组术前髌骨外移率、髌骨倾斜角、Kujala评分、Lysholm评分分别为19．56％±0．62％、12．35°±0．66°、（57．46±3．08）分、（52．20±6．94）分，术后分别为10．24％±0．66％、8．78°±0．92°、（92．53±3．32）分、（90．41±2．90）分；两组以上项目术前与术后比较差异均有统计学意义（P〈0．05）。但两组滑车沟角、TT-TG术前与术后比较差异均无统计学意义（P〉0．05）。以上所有项目术前、术后两组间比较差异均无统计学意义（P〉0．05）。结论LRR联合MPFL-R术和关节镜下LRR联合MPFL-R术治疗复发性髌骨脱位均能改善髌股关节的对位关系，提高髌骨的稳定性，获得良好疗效。

Objective To compare the short-term outcomes between lateral retinacular release （LRR） via a prolonged incision versus arthroscopic LRR in osteofascial medial patellofemoral ligament re- construction （MPFL-R） for recurrent patellofemoral dislocation. Methods From May 2012 to March 2015, 51 patients with recurrent patellofemoral dislocation were treated at the Department of Joint Surgery, The Third Affiliated Hospital to Hebei Medical University. They were 16 males and 35 females, aged from 20 to 36 years （mean 27.2 years）. Of them, 28 underwent LRR via a prolonged incision in MPFL-R （incision group） and 23 did arthroscopic LRR in MPFL-R （microscopic group） . Imaging changes were assessed by comparing preoperative and postoperative values of patella extensibility, patellar tilt angle, trochlear groove angle and tibial tuberosity-trochlear groove spacing （TT-TG）; the knee joints were scored with Kujala and Lysholm functional rating systems at the last follow-ups. Results The 2 groups were compatible due to insignificant differences in the general data between them preoperatively （ P 〉 0. 05）. The 51 patients were followed up for 10 to 32 months （average, 20 months）. The rate of dislocation in the incision and microscopic groups were 0 and 8.7% （2/23）, respectively. There were no such complications in either group as patellar fracture, deep venous thrombosis of the lower extremity or limited joint extension or flexion± The last follow-ups revealed that no patients in either group were inflicted with patellofemoral re-dislocation. In the incision group, the patella extensibility, patellar tilt angle, Kujala score and Lysholm score were, respectively, 19.65% ＋ 0. 75%, 12.39°＋0. 76°, 56.37 ＋2.94 points and 51.64 ＋6.22 points preoperatively, and 10.34% ＋ 0.60%, 8.83° ＋ 0. 89°, 92. 68 ± 2.75, and 90. 71 ＋ 1.91 points postoperatively; in the microscopic group, the patella extensibility, patellar tilt angle, Kujala score and Lysholm score were, respectively, 19.56% ± 0. 62% , 12.35° ± 0. 66°, 57.46 ± 3.08 points and 52. 20 ＋ 6.94 points preoperatively, and 10. 24% ± 0. 66%, 8.78° ＋ 0. 92°, 92.53 ＋ 3.32 points and 90.41 ＋ 2.90 points postoperatively. There were significant differences between the preoperative and postoperative values in both 2 groups （ P 〈 0.05） . However, there were no significant differences between the preoperative and the postoperative values in trochlear groove angle or TT-TG in either group （ P 〉 0. 05）. There were no significant differences between the 2 groups in all the above preoperative and postoperative values （ P 〉 0. 05） . Conclusion In MPFL-R for recurrent patellofemoral dislocation, both LRR via a prolonged incision and arthroscopie LRR can improve the patellofemoral joint alignment and stability of the tibia, leading to good short-term outcomes.