关节镜辅助下内侧支持带紧缩缝合术治疗青少年髌骨脱位

Arthroscopic treatment of patellar dislocation with medial retinaculum tightening in adolescent

目的评价关节镜辅助下内侧支持带紧缩术治疗青少年髌骨脱位的临床疗效。方法选取2010年1月至2016年7月石河子大学第一附属医院收治36例(38膝)青少年髌骨脱位行关节镜辅助下内侧支持带紧缩缝合术的患者,收集患者术前及术后J-sign征和恐惧试验变化及IKDC、Lysholm、Kujala评分。结果与术前相比,术后随访3、6、12个月患者IKDC评分分别提高了35.34%、43.16%和53.71%(P<0.01),Lysholm评分提高了74.73%、89.89%和110.9%(P<0.01),Kujala评分提高了78.37%、92.62%和117.8%(P<0.01),均呈上升趋势,急性髌骨脱位与复发性髌骨脱位患者随访期间各评分变化差异无统计学意义(P>0.05);术后12个月J-sign试验阳性率较术前降低了52.63%,恐惧试验阳性率较术前降低了57.89%(P<0.01)。IKDC膝关节功能主观评分、Lysholm评分及Kujala评分术后明显增加,膝关节活动水平及整体满意度明显增加。结论关节镜辅助下内侧支持带紧缩缝合术治疗青少年髌骨脱位创伤较小,短期疗效确切,术后患者膝关节功能改善明显,手术操作简便,易于掌握。

Objective To evaluate the therapeutic effects of medial retinaculum tightening under the arthroscope for the adolescent patella dislocation.Methods From January 2010 to July 2016,36 patients(38 knees)of adolescent patellar dislocations were treated by arthroscope with the medial retinaculum tightening.The patient was evaluated preoperatively and postoperatively,including the J-sign,apprehension test,scores of International Knee Documentation Committee questionnaire(IKDC),Lysholm and Kujala.Results During the followed-up at 3,6 and 12 months after the operation,IKDC scores were improved 35.34%,43.16%and 53.71%respectively compared to the preoperative data(P<0.01).The Lysholm scores were improved 74.73%,89.89%and 110.9%(P<0.01).The Kujala scores were improved 78.37%,92.62%and 117.8%(P<0.01).All the scores showed a rising trend.There was no significant difference in the scores of patients with acute patellar dislocation group and recurrent patellar dislocation group during the follow-up(P>0.05).The positive rate of J-sign test decreased by 52.63%and the apprehension test decreased by 57.89%(P<0.01)12 months after the operation.IKDC,Kujala and Lysholm scores increased obviously after the operation,and the knee joint activity level and overall satisfaction increased significantly.Conclusion Arthroscopic treatment with medial retinaculum tightening for adolescent patellar dislocation can result in positive effects,and it is easy to operate and grasp.