关节镜下臀肌挛缩松解术治疗髌股关节不稳定的疗效分析

Efficacy of arthroscopic release of gluteal muscle contracture in treatment of patellofemoral instability

目的探讨关节镜下臀肌挛缩松解术对改善髌股关节不稳定的疗效。方法选取了66例在2016年1月-2018年12月于同济大学附属第十人民医院行关节镜下臀肌挛缩松解术的患者,所选的研究对象术前必须伴有髌股关节不稳定的症状和相关影像学证据。并于术前术后评估患者的膝关节Lysholm功能评分,运用CT检查获取髌股关节相关指标并进行统计分析。结果所有入组患者均获得了较好的临床效果,术前的髋关节活动弹响和异常姿势症状明显改善。此外,术后患者膝关节的疼痛也有显著的缓解,术前术后的Lysholm评分差异有统计学意义(P<0.05)。在膝关节CT影像学的对比中可以发现,髌骨倾斜角,髌股指数和髌骨外移度指标在术后明显减小(P<0.05)。平均的外侧髌股角术后明显增大(P<0.05)。结论关节镜下臀肌挛缩松解术可以显著改善髌骨的外移和倾斜,从而增强髌股关节的稳定性。

Objective To analyze the efficacy of arthroscopic release of gluteal muscle contracture(GMC) in treatment of patellofemoral instability. Methods Sixty six patients with patellofemoral instability who underwent arthroscopic release of GMC from January 2016 to December 2018 in Shanghai Tenth People’s Hospital were included in the study. The Lysholm score and CT scan findings of the knee were compared before and after operation. Results Satisfactory clinical outcomes were achieved in all patients, snapping hip and abnormal posture were improved, the knee pain was significantly relieved. There was significant difference in Lysholm scores before and after operation(P<0.05). The CT findings showed that the mean lateral patellar displacement(LPD), patellofemoral index(PFI), and patellar tilt angle(PTA) were significantly decreased(P<0.05), the mean lateral patellofemoral angle(LPFA) was significantly increased after operation(P<0.05). Conclusion The arthroscopic release of gluteal muscle contracture can significantly improve the tilt and lateral shift of the patella and enhance the stability of the patellofemoral joint.