针刀治疗全膝关节置换术后髌骨外侧高压综合征患者的疗效观察

Clinical observation on lateral patellar hypertension syndrome after total knee arthroplasty treated with needle knife

目的:探讨针刀松解髌外侧支持带治疗全膝关节置换术(TKA)后髌骨外侧高压综合征(ELPS)的临床疗效。方法:选择2018年6月—2019年10月TKA术后髌骨外侧高压综合征患者24例(24膝),均采用针刀松解髌外侧支持带治疗。统计术前、术后2周及末次随访患者的VAS评分、Lysholm评分、Kujala评分;拍摄屈曲30°髌骨轴位片,测量治疗前、治疗后髌骨的适合角、髌骨外倾角;按照Insall评价标准评估患者满意度;记录术后并发症以评估安全性。结果:所有患者术后均未出现针孔红肿、感染、失稳或脱位等并发症。24例均获随访8个月至24个月,平均(14.21±2.97)个月。VAS评分术后较术前VAS明显降低(P<0.05),差异有统计学意义;Lysholm评分术后较术前明显升高(P<0.05);术后各时间点Kujala评分较术前均明显升高(P<0.05),差异有统计学意义。24例患者髌骨适合角、外倾角术后较术前降低(P<0.05),差异有统计学意义。末次随访时按照Insall评价标准评定满意度,获优15例、良7例、可2例,满意度为91.7%。结论:针刀松解髌外侧支持带治疗TKA术后ELPS,是安全有效的治疗方法,短期随访结果满意。

Objective:To investigate the clinical effect of needle knife release of lateral patellar retinaculum in the treatment of lateral patellar hypertension syndrome after total knee arthroplasty(TKA). Methods:24 patients(24 knees)with lateral patellar hypertension syndrome after TKA from June 2018 to October 2019 were treated with needle knife release of lateral patellar retinaculum. VAS score,Lysholm score and Kujala score of patients before operation,2 weeks after operation and the last follow-up were counted;The patellofemoral axial film with 30° flexion was taken to measure the patellar fit angle and patellar camber before and after treatment;Patients′ satisfaction was evaluated according to Insall evaluation criteria.Postoperative complications were recorded to assess safety. Results:all patients had no complications such as pinhole swelling,infection,instability or dislocation. All 24 cases were followed up from 8 to 24 months,with an average of(14.21±2.97)months. VAS score after operation was significantly lower than that of before operation(P<0.05). Lysholm score was significantly higher after operation than before operation(P <0.05). Kujala score at each time point after operation was significantly higher than that of before operation(P<0.05). The patellar fitness angle and camber angle of 24 patients were lower than those of before operation(P <0.05). At the last follow-up,according to the Insall evaluation standard,the satisfaction was 91.7%. Conclusion:It is safe and effective to release the lateral patellar retinaculum with needle knife in the treatment of ELPS after TKA.The short-term follow-up results are satisfactory.