髌骨半脱位的病因探讨和疗效观察(附61例报告)

A study in the causes and therapeutic effects of patellar subluxation

目的 探讨髌骨半脱位的病因及手术治疗效果。方法 6 1例 110膝髌骨半脱位患者髌骨的形态均为WibergⅡ、Ⅲ型 ,伴有外侧髌股关节骨关节病者 5 2例 98膝 ;高位髌骨 4 7例 94膝 ;外伤后股四头肌内侧头肌张力不良 5例 8膝。Q角 2 0°～ 35°。手术方式包括 :髌骨外侧支持带充分松解 (110膝 ) ;髌骨内侧支持带紧缩、股内侧肌头移位至髌骨前内侧 (8膝 ) ;髌骨外侧部分切除 (5 6膝 ) ;软骨成型、软骨下骨外露区域密集钻孔 (110膝 ) ;胫骨结节前、内侧移位 (98膝 ) :平均内移 1.0cm、前移 1.2cm。术中见全部病例髌骨外侧支持带均明显增厚。术后第 3日用每分钟次数 (CPM)开始膝关节屈伸功能锻炼。术后 1年局麻下取出内固定螺钉。结果 6 1例均获得随访 ,平均随访 2 .5年。 5 3例 98膝 (89% )效果优良 :上、下楼梯和下蹲、站立时前膝痛症状消失或有明显的减轻 ,膝关节屈伸功能正常 ,能正常进行日常的工作和生活。 8例 12膝 (11% )效果较差 ,全部为髌股关节软骨严重磨损者 ,表现为前膝痛仍然明显。结论 髌骨半脱位病因主要与高位髌骨、过大的Q角、外侧支持带的挛缩肥厚、髌骨的发育类型以及股四头肌内侧头肌张力不良有关。根据病因及病理改变选择髌骨外侧支持带松解、股内侧肌头移位、髌骨外侧部分切除、胫骨?

Objective To study the causes of patellar subluxation and analyze the treatment effects.Methods Patellar subluxation was diagnosed for 61 cases (110 knees) with chronic anterior knee pain under fifty by Merchant technique.The shapes of patella were both type Ⅱ and Ⅲ of Wiberg shapes.There were 52 cases (98 knees) with lateral patellofemoral arthritis,47 cases (94 knees) with patella alta and 5 cases (8 knees) with insufficient of vastus medialis obliques muscle function.The Q angle ranged from 20 degrees to 35 degrees.Thickening and tightness of the lateral retinaculum could be observed during operation.The methods of the operations involved lateral retinaculum release for 110 knees,vastus medialis obliques muscle transfer for 8 knees,partial lateral facetectomy for 56 knees,debridement procedures for 110 knees,and anteromedial transfer of the tibial tubercle for 98 knees.Results All patients were followed up for 6 months to 7 years (an average times 2.5 years).The excellent and good rate were 89% (53 cases,98 knees),anterior knee pain disappeared or was obviously alleviated for these cases,and the functional recoveries of knee joint were mostly excellent.The poor rate was 11%(8 cases,12 knees),anterior knee pain remained for these cases who suffered from seriously articular cartilage lesions.Conclusions The main causes of patellar subluxation consisted of patella alta,the Q angle raised,patellar type Ⅱ and Ⅲ of Wiberg shapes,thickening and tightness of the lateral retinaculum and insufficient of vastus medialis obliquus muscle function.According to the causes,the procedures were performed such as lateral retinaculum release,vastus medialis obliquus muscle transfer,partial lateral facetectomy,debridement procedures,anteromedial transfer of the tibial tubercle,the treatment effects were satisfactory.