关节镜下髌骨支持带调整术治疗青少年 复发性髌骨脱位的近期疗效

Short term effect of arthroscopic treatment of adolescent recurrent patellar dislocation through patellar retinaculum adjustment

摘要:

目的 探讨关节镜下髌骨内外侧支持带调整术治疗青少年复发性髌骨脱位的近期临床疗效。方法 对2002年6月～2009年8月收治的25例青少年复发性髌骨脱位患者进行回顾性分析，其中21例22膝获完整随访。左膝12侧，右膝10侧。患者既往髌骨脱位2～6次。首次脱位至手术时间3～116个月，平均28.5个月。所有患者术前均有不同程度的膝关节疼痛和剧烈活动时不稳感，髌骨外推恐惧试验均为阳性，4例磨髌试验阳性，5例伸膝抗阻痛阳性。术前常规行膝关节正侧位和髌骨轴位X光片检查，记录术前Q角（14.3±2.7）°，术前患侧大腿较健侧萎缩（2.2±0.83）cm。患者术前国际膝关节评分委员会（IKDC）评分（44.3±3.3）分、Lysholm评分（55.7±3.7）分。所有患者均于关节镜下行髌骨外侧支持带松解、内侧支持带缝合紧缩术治疗，术后行正规功能康复。结果 21例22膝获随访，随访时间24～54个月，平均32个月。术后患膝活动良好，随访期未见脱位及患膝发育异常。术后24个月观察，髌骨外推恐惧试验阳性3例；Q角（15.4±2.5）°，与术前比较差异有显著性（P =0.0142）；患侧大腿较对侧萎缩（1.2±0.43）cm，与术前比较差异有显著性（P =0.0224）；IKDC评分（72.5±4.1）分、Lysholm评分（77.3±3.5）分，均较术前显著提高（P =0.0072，P =0.0023）。结论 关节镜下髌骨支持带调整术治疗无严重膝关节发育异常的青少年复发性髌骨脱位近期疗效满意。

Abstract:

【Objective】 To explore the clinical results of arthroscopic treatment of recurrent patellar dislocation in adolescents. 【Methods】 Between June 2002 and August 2009, 25 adolescent patients with recurrent patellar dislocation underwent arthroscopic treatment, and 21 of them (22 knees, 12 left and 10 right) completed the follow-up, The disease course was 3 to 116 months (mean 28.5 months). All patients experienced 2 to 6 episodes of dislocation. All patients had patellar instability sense and knee arthralgia during strenuous exercise. Before operation, all the patients showed positive apprehension test. Every case underwent X-ray examination, some people underwent CT or MRI scan. The preoperative Q angle was (14.3±2.7)°. The International Knee Documentation Committee (IKDC) and Lysholm scores were (44.3±3.3)and(55.7±3.7) respectively. All patients underwent arthroscopic MRP (medial retinacular placation) and LRR(lateral retinacular release) minimally invasive procedure. 【Results】 All incisions werehealed without complication. All the patients were followed up 24-54 months (32 months on average). The range of motion returned to normal. There was no recurrence of dislocation during follow-up. At 24 months after operation, 3 patients showed positive apprehension test, the Q angle was (15.4±2.5)°, and the difference of thigh circumferences was(1.2±0.43)cm; the IKDC score and Lysholm score were(72.5±4.1)and(77.3±3.5). There were statistically significant differences between preoperation and postoperation (P <0.05). 【Conclusion】 Arthroscopic treatment (MRP plus LRR) can improve the limb function of adolescence with recurrent patellar dislocation obviously.