经骨缝合手术治疗急性髌骨脱位合并髌骨软骨Peeloff损伤早期疗效观察

Observation of early curative effect of transosseous suture surgery in treatment of acute patellar dislocation combined with patellar cartilage Peeloff injury

目的评价经骨缝合手术治疗急性髌骨脱位合并髌骨软骨骨折(Peeloff损伤)的早期临床疗效。方法回顾性分析自2019-05—2020-03诊治的15例急性髌骨脱位合并髌骨软骨Peeloff损伤,膝关节镜检查并确诊髌骨软骨缺损,关节腔内找到与缺损区域吻合的游离软骨片,关节镜下或内侧小切口取出游离软骨片;再作髌内侧切口,将游离软骨片复位并在其边缘选取4个合适进针点,用带孔克氏针在髌骨主体上从内向外垂直钻孔,每两孔之间导入可吸收缝线,经孔道将克氏针抽出时带出缝线并打结。结果 15例均获得随访,随访时间平均8(3~13)个月。术后3个月MRI显示所有患者髌骨关节面软骨骨折均愈合。2例出现早期髌股关节疼痛(1例VAS评分为4分,1例VAS评分为5分),经康复治疗后好转,其余13例疼痛VAS评分平均1.8(1~3)分。末次随访时Tegner运动评级:3级5例,4级9例,5级1例。末次随访时膝关节功能Lysholm评分80~96(88.9±4.7)分,其中优6例,良7例。结论关节镜下探查可确诊急性髌骨脱位合并的髌骨软骨Peeloff损伤,采用可吸收缝线经骨缝合固定髌骨关节面软骨片无需特殊内固定器械及二次手术取出,既能实现软骨稳定固定、正常愈合,又能保证膝关节功能良好恢复。

ObjectiveTo evaluate the early clinical effect of transosseous suture surgery in the treatment of acute patellar dislocation combined with patellar cartilage fracture(Peeloff injury).MethodsFifteen cases of acute patellar dislocation combined with patellar cartilage Peeloff injury from May 2019 to March 2020 were analyzed retrospectively.The patellar cartilage defect was diagnosed by knee arthroscopy,the free cartilage piece was found in the joint and matched the defect.The free cartilage piece was removed under arthroscopy or small medial incision.Through the medial incision,the free cartilage piece was reposited and four suitable needle entry points were selected at its edge.A perforated Kirschner wire was used to drill from inside to outside vertically in patella,and an absorbable suture was introduced into every two holes.Tied the knot while pulled out the Kirschner wire and took out the suture.ResultsAll the 15 cases were followed up for an average of 8(3-13)months.Three months after operation,MRI showed that the cartilage fractures of patella healed in all patients.Two cases had early patellofemoral joint pain(VAS score 4 points in 1 case,VAS score 5 points in 1 case),both improved after rehabilitation.The average VAS score of the other 13 cases was 1.8(1-3)points.Tegner activity scale:grade 3 in 5 cases,grade 4 in 9 cases and grade 5 in 1 case.Lysholm score at last follow-up was 80-96(88.9±4.7)points,of which 6 cases were excellent and 7 cases were good.ConclusionAcute patellar dislocation combined with patellar cartilage Peeloff injury can be diagnosed explicitly by arthroscopy.Patellar cartilage fixed transosseously by absorbable suture requires no special internal fixation and secondary operation,can achieve stable cartilage fixation and normal healing,and ensure good recovery of knee function.