关节镜辅助下小切口内侧髌股韧带重建术治疗创伤性复发性髌骨脱位的临床效果

Clinical Effects of Arthroscopic-Assisted Small Incision Medial Patellofemoral Ligament Reconstruction on Patients with Traumatic Recurrent Patellar Dislocation

目的探讨关节镜辅助下小切口内侧髌股韧带重建术(MPFL)治疗创伤性复发性髌骨脱位(RDP)患者的临床效果。方法选取2019年1月至2021年3月汝州市人民医院收治的88例创伤性RDP患者。根据采取的手术方案分成MPFL治疗组(44例)和常规治疗组(44例)。常规治疗组接受改良上畸法治疗,MPFL治疗组接受关节镜辅助下小切口MPFL治疗。对比两组术前、术后1个月、术后3个月膝关节活动度、Q角变化、Lysholm膝关节评分、髌骨Kujala评分,术前、术后6h应激指标[主要包括促肾上腺皮质激素(ACTH)、皮质醇(Cor)]水平。结果MPFL治疗组患者术后1个月、术后3个月的膝关节活动度较常规治疗组升高,Q角较常规治疗组降低(P<0.05);MPFL治疗组患者术后1个月、3个月的Lysholm评分较常规治疗组升高(P<0.05);MPFL治疗组患者术后1个月、3个月的Kujala评分较常规治疗组明显升高(P<0.05);两组患者术后6h血清ACTH、Cor水平较术前升高,但MPFL治疗组术后6h血清ACTH、Cor水平较常规治疗组降低(P<0.05)。结论与改良上畸法治疗创伤性RDP患者相比,应用关节镜辅助下小切口MPFL治疗在改善患者的膝关节功能、促进病情恢复方面更具优势,且对机体产生的创伤更小。

Objective To explore the effect of arthroscopic-assisted small incision medial patellofemoral ligament(MPFL)in the treatment of patients with traumatic recurrent dislocation of patellar(RDP).Methods A total of 88 patients with traumatic RDP in Ruzhou People's Hospital from January 2019 to March 2021 were selected and divided into MPFL group(44 cases)and conventional group(44 cases)according to the different operation plans.Patients in the conventional group received modified upper deformity treatment,and patients in the MPFL group received arthroscopy-assisted small incision MPFL treatment.Changes of knee range of motion,Q-angle,Lysholm knee score,patella Kujala score before and after 1 month,3 months of operation,stress indicators[mainly including adrenocorticotropic hormone(ACTH)and cortisol(Cor)]before and after 6 h of operation were compared between MPFL group and conventional group.Results After 1 month,3 months of operation,knee range of motion,Lysholm scores and Kujala scores in the MPFL group were obviously higher than those in the conventional group,and Q-angle was obviously lower than that in the conventional group(P<0.05).The serum levels of ACTH and Cor in the two groups after 6 h of operation were higher than before the operation.After 6 h of operation,the serum levels of ACTH and Cor in the MPFL group were obviously lower than those in the conventional group(P<0.05).Conclusion Compared with the modified upper deformity method for the treatment of traumatic RDP patients,the application of arthroscopy-assisted small incision MPFL treatment has more advantages in improving knee joint function,promoting disease recovery,and causing less trauma to the body.