关节镜下直线与L形松解外侧支持带治疗髌骨外侧挤压综合征合并髌股关节炎的效果比较

Comparison of linear and L-shaped release of lateral retinaculum under arthroscopy in treatment of lateral patellar compression syndrome complicated with patellofemoral arthritis

目的比较关节镜下直线松解与L形松解髌骨外侧支持带治疗髌骨外侧挤压综合征合并髌股关节炎的疗效。方法回顾性分析自2014-02—2021-09诊治的74例髌骨外侧挤压综合征合并髌股关节炎,其中直线松解组39例在关节镜下常规直线松解髌骨外侧支持带,同时行髌骨外侧打磨成形、软骨病灶刮除清理、微骨折、游离体取出、滑膜清理等联合术式治疗;L形松解组35例在关节镜下L形松解髌骨外侧支持带,不伤及股外侧肌,其余术式同直线松解组。比较直线松解组与L形松解组术后3个月、6个月、12个月膝关节功能Lysholm评分、膝关节IKDC评分、膝关节功能Kujala评分、疼痛VAS评分、髌骨外倾角。记录术后主观满意度、股四头肌萎缩率。结果74例均获得随访,随访时间12~27(16.58±4.19)个月。所有患者切口一期愈合,顺利拆线,术后1周复查下肢静脉彩色多普勒超声,均无深静脉血栓形成。术后3个月、6个月、12个月L形松解组膝关节功能Lysholm评分、膝关节IKDC评分、膝关节功能Kujala评分均高于直线松解组,差异有统计学意义(P<0.05)。术后3个月、6个月、12个月直线松解组与L形松解组疼痛VAS评分、髌骨外倾角差异无统计学意义(P>0.05)。直线松解组术后3个月6例(15.38%)股四头肌萎缩,末次随访时6例(15.38%)主观满意度差;L形松解组术后2例(5.71%)股四头肌萎缩,末次随访时3例(8.57%)主观满意度差。多元线性回归分析结果显示两组股四头肌萎缩、疼痛VAS评分均对满意度有显著影响,呈负相关(P<0.05);两组股四头肌萎缩Beta值>疼痛VAS评分Beta值,股四头肌萎缩对满意度的影响大于疼痛VAS评分。结论与常规直线松解比较,关节镜下L形松解髌骨外侧支持带治疗髌骨外侧挤压综合征合并髌股关节炎不损伤股外侧肌,且术后膝关节功能更好,患者满意度高,肌肉萎缩发生率低,方法简便,可重复率高,值得推广应用。

Objective To compare the clinical effects of traditional linear release and L-type release of lateral patellar retinaculum under arthroscopy in treatment of lateral patellar compression syndrome complicated with patellofemoral arthritis.Meth⁃ods Seventy-four patients with lateral patellar compression syndrome complicated with patellofemoral arthritis diagnosed and treated from February 2014 to September 2021 were retrospectively analyzed.In the linear release group,thirty nine patients received traditional linear release of the lateral patella retinaculum under arthroscopy,and at the same time,the lateral patella was polished and shaped,the cartilage focus was scraped and cleaned,the microfracture,the free body was taken out,and the synovium was cleaned up.In the L-shape release group,the lateral patellar retinaculum of 35 patients was released in the L-shape release under arthroscopy without injuring the vastus lateralis,and the other operation methods were the same as those in the linear group.Lysholm score,IKDC score,Kujala score,VAS pain score and lateral patella tilt angle were recorded at 3,6 and 12 months after operation during follow-up,and subjective satisfaction and quadriceps atrophy probability were recorded to compare clinical effects.Results All patients were followed up for 12 to 27(16.58±4.19)months.All the 74 incisions were healed in the first stage and stitches were removed successfully.Color ultrasound of lower limb veins was reexamined one week after surgery,and no deep vein thrombosis was found.Lysholm,IKDC and Kujala scores in the L-shape release group were better than those in the linear line group at 3,6 and 12 months after operation(P<0.05);There was no significant difference in pain VAS score and lateral patella tilt angle between the linear release group and the L-shape release group at 3 months,6 months and 12 months after surgery(P>0.05).In the linear release group,there were 6 cases of quadriceps atrophy(15.38%)at 3 months after operation,and 6 cases(15.38%)of poor subjective satisfaction at the last follow-up.In the L-shaped release group,there were 2 cases(5.71%)of quadriceps atrophy and 3 cases(8.57%)of poor subjective satisfaction at the last followup.In multiple linear regression,quadriceps atrophy and VAS score had a significant effect on satisfaction(P<0.05),showing a negative correlation.Quadriceps atrophy Beta value was greater than VAS score Beta value in both groups,the effect of quadriceps atrophy on satisfaction was greater than VAS score.Conclusion Arthroscopic L-type release of lateral patella retinaculum for the treatment of lateral patella compression syndrome combined with patellofemoral arthritis does not damage vastus lateralis compared with traditional linear release.It has better knee function after operation,higher satisfaction,lower muscle atrophy rate,simpler method,higher repeatability,and is worthy of reference by peers.