关节镜下内侧支持带重叠缝合联合外侧松解治疗青少年创伤性髌骨脱位的临床研究

Clinical study of traumatic patella dislocation by arthroscopic medial retinaculum tightening combined with lateral patellar retinaculum in adolescents

目的探讨膝关节镜下内侧支持带重叠缝合联合外侧支持带松解治疗伴有撕脱性骨折的创伤性髌骨脱位的临床疗效。方法回顾性分析2018年5月至2021年5月秦皇岛市第一医院诊治的30例青少年初次创伤性髌骨脱位合并髌骨内侧缘撕脱性骨折的患者,均在关节镜下采用内侧支持带重叠缝合联合外侧支持带松解方法治疗。评估膝关节优良率,术后6个月及1年的Kujala髌股关节评分、Lysholm膝关节评分、IKDC膝关节评分的改善情况,记录术前、术后6个月、术后1年的膝关节活动度、髌骨倾斜角、髌骨适合角及髌骨外移率。结果①30例患者术后均恢复良好,髌骨位置解剖复位,术后平均随访时间为12.1个月(10~18个月),均无复发性脱位或半脱位发生;②膝关节优良率、Kujala髌股关节评分、Lysholm评分、IKDC评分分别由术前的3.3%、(45.3±2.2)分、(36.8±2.5)分、(53.5±4.9)分提高至术后1年的93.3%、(92.9±2.2)分、(94.8±3.5)分、(98.3±5.0)分,差异均具有统计学意义(P<0.05);③膝关节活动度由术前的(25.3±4.5)°提高至术后1年的(125.4±3.2)°,髌骨倾斜角、髌骨适合角及髌骨外移率分别由术前的(12.5±1.8)°、(19.2±1.9)°、(18.5±2.3)%降至术后1年的(5.6±0.7)°、(6.8±1.0)°、(6.9±0.8)%,差异均具有统计学意义(P<0.05)。结论膝关节镜下内侧支持带重叠缝合联合外侧支持带松解治疗伴有撕脱性骨折的创伤性髌骨脱位安全有效,可获得稳定的髌骨运动轨迹,术后中短期随访影像学指标和临床功能评分满意。

Objective To investigate the clinical effect of traumatic patella dislocation with avulsion fracture by medial retinaculum tightening combined with lateral patellar retinaculum.Methods Thirty adolescents of traumatic patellar dislocation with avulsion fracture were analyzed retrospectively from May 2018 to May 2021,and all patients were treated by medial retinaculum tightening combined with lateral patellar retinaculum under arthroscopy.The improvement of Kujala score,Lysholm knee score and IKDC score were evaluated after operation.The range of motion,patellar tilt angle,patellar congruence angle and patellar lateral displacement rate were recorded before operation,6 months and 1 year after operation.Results①All patients recovered well after operation,the position of patella was in anatomical reduction,the average follow-up time was 12.1 months(10-18 months),and no recurrent dislocation or subluxation occurred.②Postoperative excellent and good rates of knee joint,Kujala score,Lysholm score and IKDC score all improved when compared with preoperative ones,from 3.3%,(45.3±2.2),(36.8±2.5)and(53.5±4.9)preoperatively to 93.3%,(92.9±2.2),(94.8±3.5)and(98.3±5.0)at 12 months postoperatively,and the differences between preoperation and postoperation showed statistical significance(P<0.05).③The range of motion increased from(25.3±4.5)°before operation to(125.4±3.2)°at 12 months postoperatively,the patellar tilt angle patellar,congruence angle and patellar lateral displacement rate decreased respectively,from(12.5±1.8)°,(19.2±1.9)°and(18.5±2.3)%preoperatively to(5.6±0.7)°,(6.8±1.0)°and(6.9±0.8)%at 12 months postoperatively,and the differences between preoperation and postoperation showed statistical significance(P<0.05).Conclusion The treatment of traumatic patella dislocation with avulsion fracture by medial retinaculum tightening combined with lateral patellar retinaculum is safe and effective under arthroscopy,stable patellar trajectory can be obtained,and the imaging indexes and clinical function scores are satisfactory in the medium and short-term follow-up.