关节镜下髌内侧支持带紧缩术治疗创伤性髌骨不稳的疗效分析

Arthroscopic medial retinaculum plication in treatment of traumatic patellar instability

摘要:

目的 探讨关节镜下髌内侧支持带紧缩并外侧支持带松解术治疗创伤性髌骨脱位的疗效。 方法 2012 年3 月-2015 年12 月收治创伤性髌骨不稳患者17 例。其中，男6 例，女11 例；年龄14 ～ 37 岁（平 均16.8 岁）。所有患者在第一次脱位时均有外伤史，术前脱位次数1 ～ 4 次。术中先进行关节镜检查，评估髌 骨轨迹和髌股关节的匹配关系；然后在关节镜监视下紧缩缝合内侧支持带并松解外侧支持带。结果 所有患 者术后均获随访，随访9 ～ 28 个月，平均（19.7±1.3）个月。术后无髌骨再脱位发生，恐惧试验阴性，关节 活动度均在正常范围。术后CT 显示髌股关节解剖关系恢复正常15 例，髌骨轻度半脱位2 例。术前Lysholm 评分为（51.8±4.5）分，术后（92.4±2.8）分。术后1 年患膝功能采用Insall 评分标准，优11 膝，良5 膝，可 1 膝，优良率94.1%。结论 关节镜下髌内侧支持带紧缩并外侧松解术治疗创伤性髌骨不稳，具有创伤小、恢 复快和复发率低等优点，近期效果可靠。

Abstract:

Objective To explore the short-term results of arthroscopic medial retinaculum placation (MRP) and lateral retinaculum release (LRR) in treatment of patients with traumatic patellar dislocation. Methods 17 cases (6 male, 11 female) with traumatic patellar instability from March 2012 to December 2015, with an average age of 16.8 years old (range from 14 to 37 years old). All of the patients had a clear history of trauma and experienced patellar dislocation for the first time, the patients experienced patellar dislocation 1 to 4 times preoperatively. The arthroscopic examination was undertaken before the repairing to observe the injured site of the medial retinaculum and the patellar track, as well as the dynamic patellofemoral congruence. All patients underwent arthroscopic MRP and LRR minimally invasive procedure. Results All patients were followed up for 9 to 28 months averaging (19.7 ± 1.3) months. The fear test was negative after operation. There was no redislocation during follow-up and their ranges of motion returned to normal. Postoperative CT images showed 15 cases regained normal anatomical relation of patellofemoral joint. 2 cases had mild semi-dislocation. Lysholm’s score averaging (51.8 ± 4.5) points preoperatively and (92.4 ± 2.8) points postoperatively. According to Insall scale, the results were excellent in 11 knees, good in 5 knees, and fair in 1 knee at 1 year after operation with an excellent and good rate of 94.1%. Conclusions Arthroscopic MRP and LRR showed satisfactory results with limited morbidity in the shortterm follow-up. This method can make the patients smaller wound,quicker recovered and lower recurrence rate.