急性创伤性髌骨脱位合并髌骨高位的手术治疗选择

Treatment options for acute traumatic dislocation of patella combined with patella alta

目的对急性创伤性髌骨脱位合并髌骨高位一期手术矫正脱位的同时是否矫正髌骨高位的临床疗效进行对比。方法随机选取自2013-07—2015-06收治的创伤性髌骨脱位合并髌骨高位51例作为研究对象,均为髌骨外侧单侧脱位,按手术方法的不同分为2组:治疗组24例行手术矫正髌骨脱位和髌骨高位,常规组27例只矫正髌骨脱位。随访时记录术后3、6、12、36个月的Lysholm、Kujala评分比较疗效。结果治疗组获得36～41个月,平均38.9个月的随访;常规组获得36～43个月,平均39.5个月的随访;随访时2组患肢膝关节活动度满意,患肢无明显肌肉萎缩,查体无髌骨脱位,髌骨轨迹正常,髌骨恐惧征阴性。术后3个月2组Lysholm评分较术前组内比较和Kujala评分较术前组内比较,差异均有统计学意义(P <0.001);术后3、6个月时2组Lysholm、Kujala评分比较,差异均无统计学意义(P>0.05);术后12、36个月时治疗组Lysholm、Kujala评分比常规组更高,差异均有统计学意义(P <0.05)。结论创伤性髌骨脱位合并髌骨高位,手术同时矫正脱位和髌骨高位,术后中期Lysholm评分和Kujala评分更高,患肢膝关节功能好,患者满意度高,长期效果好,值得临床推广应用。

Objective To compare the clinical treatment effect of surgical treatment of patella alta while treating the traumatic dislocation of patella and without treatment of patella alta for patients who were acute traumatic dislocation of patella with patella alta. Methods From July 2013 to June 2015, fifty-one cases of traumatic dislocation of patella with patella alta were randomly selected for the study. All 51 cases were unilateral lateral dislocations. They were divided into two groups according to the different surgical methods. Treatment group: 24 patients underwent surgical correction of patella dislocation and patella alta. Conventional group: 27 patients only underwent surgical treatment of patella dislocation. During the followup, Lysholm and Kujala scores were recorded at 3, 6, 12 and 36 months after surgery to compare the efficacy. Results Treatment group was followed up for 36 to 41 months (3&9 months on average), and conventional group was followed up for 36 to 43 months (39.5 months on average). During the follow-up period, patients of two groups had satisfactory knee motion and no obvious muscle atrophy. There was no patella redislocation after surgery, the patella trajectory was normal and patella fear test (-). The difference between Lysholm scores and Kujala scores was significantly higher than their own group at 3 months after surgery (P <0.001). There were no significant differences in Lysholm scores and Kujala scores between the two groups at 3 months and 6 months after surgery (P >0.05). Compared with the conventional group, Lysholm scores and Kujala scores were higher in the treatment group at 12 months and 36 months after operation, and the difference was statistically significant (P <0.05). Conclusion To treat patella dislocation and correct the patella alta at the same time for traumatic dislocation of patella with patella alta, can achieve higher Lysholm scores and Kujala scores in the middle postoperative period, good knee joint function of the affected limb, high patient's satisfaction, and good long-term postoperative effect. It is worthy of being widely applied in clinical practice.