摘要
[目的]探讨关节镜辅助治疗创伤性髌骨脱位方法和疗效。[方法]2001年1月～2008年7月收治创伤性髌骨脱位25例,男18例,女7例。左膝9例,右膝16例,平均年龄(20.7±4.6)岁。病人入选条件:所有病人均有明确膝关节暴力外伤史,排除关节松弛和髌股关节发育异常。初次急性脱位13例,以前有脱位史近期再脱位者12例。先行关节镜检查并清理关节腔内积血和处理关节面受伤后,拇指推髌骨外缘向内,若髌骨复位无明显障碍,只做髌内侧支持带修复术;若外侧支持带紧张影响复位,则先行髌骨外侧支持带松解后再修复内侧支持带。[结果]25例病人获得随访,术后随访9～96个月,平均26.7个月。全部病例未再次发生脱位,恐惧试验全部阴性。关节活动度均在正常范围,4例关节过屈时有轻度紧张感,随访病人均恢复创伤前的生活状态。以Lysholm临床评分系统对膝关节功能进行评估,由术前平均46.5分改善为术后平均评分93.5分(80～100分)(P<0.01)。摄X线片及MRI复查,髌股关节关系正常,原关节面损伤区无扩大或进一步退变。[结论]初次创伤性髌骨脱位,若无发育异常,并不一定需要行外侧支持带松解,仅修复内侧支持带结构就可恢复髌骨的位置,对初次脱位和多次脱位病例采取不同的内侧支持带结构修复方法,可以进一步减小创伤又不影响疗效。
[Objective] To explore the clinical methods and effects of arthroscopically assisted treatment of traumatic patellar dislocation.[Method] From January 2001 to July 2008,25 patients with traumatic patellar dislocation were treated,including 18 males and 7 females with an average age of 20.7±4.6 years.All had history of knee trauma,knee laxity and dysplasia of patellofemoral joint.Thirteen patients had primary acute patellar dislocatin and 12 cases had redislocation.All the patients experienced arthroscopic examination first and removing of hemarthrosis and tackle of injured artificial surface.Then lateral rims of patella were pushed to median to determine whether there were any obstacles in the process of patella reduction.If so,only the operation of reconstruction of medial retinaculum was performed.If not,lateral patellofemoral ligament would be released first and then reconstruction of medial retinaculum was performed.[Result]Twenty-five patients were followed up postoperatively from 9-96 months with an average of 26.7 months.The patients had no recurrence of dislocation after operation,their apprehensive tests were negative and their ranges of motion returned to normal.Four of them got a slight feeling of stress when the knee was overflexed but all resumed the pre-trauma life state.The structures of patellofemoral joint were normal and the areas of injured cartilage got neither enlarged nor further degenerated on radiographs and MRI.Lysholm scores were 46.5 preoperatively and 93.5 postoperatively （P0.05）.[Conclusion]It might be not necessary to release lateral retinaculum in the treatment of primary traumatic patellar dislocation without the condition of the dysplasia of patellofemoral joint.Reconstruction of medial retinaculum only could resume the position of patella.Different ways of reconstruction of medial retinaculum could be used for not only lessening operative trauma but also maintaining treatment effect in the treatment of primary and multiple-occurred patellar dislocation.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2011年第4期265-267,共3页
Orthopedic Journal of China
关键词
髌骨脱位
髌骨内侧支持带修复
关节镜
髌骨不稳定
patellar dislocation
medial patellofemoral ligament
reconstruction arthroscopy
patellar instability
