关节镜下髌骨外侧支持带松解内侧髌股韧带紧缩缝合术治疗髌股关节炎
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摘要
[目的]观察关节镜下髌骨外侧支持带松解联合内侧髌股韧带紧缩缝合术治疗髌股关节炎的临床疗效。[方法]2012年1月~2015年12月收住的髌股关节炎患者52例共64膝,均为中重度髌股关节炎,保守治疗效果差。采用膝关节镜下髌骨外侧支持带松解、内侧髌股韧带紧缩缝合术治疗,比较术前、术后半年膝关节功能评分及影像学指标差异,评价临床效果。[结果]52例患者均顺利接受手术,平均手术时间(35.22±2.51)min,平均卧床时间(1.52±0.54)d,平均住院时间(5.91±1.14)d。所有患者切口均一期愈合,无严重并发症发生,52例患者共64膝均获得随访,随访时间12个月以上。术后所有患者膝前痛症状均明显缓解,术后3个月、末次随访时VAS评分较术前明显下降,差异具有统计学意义(P<0.05),所有患者膝关节功能均明显改善,术后3个月、末次随访时Lysholm评分、Kujala评分较术前明显增高,差异有统计学意义(P<0.05);术后3个月影像学指标髌股适合角、髌骨倾斜角和髌骨外移测量结果较术前显著减小,差异具有统计学意义(P<0.05)。[结论]关节镜下髌骨外侧支持带松解联合内侧髌股韧带紧缩术可有效治疗中重度髌股关节炎。
[Objective] To evaluate the clinical outcomes of arthroscopic lateral retinacular release combined with medial patellofemoral tightening by suture for patellofemoral arthritis. [Methods] A total of 52 patients(64 knees) with patellofemoral arthritis were surgically treated in our department from January 2012 to December 2015. All the involved knees were graded as moderate and severe patellofemoral arthritis, failed to conservative treatment. The knee arthroscopic lateral retinacular release combined medial patellofemoral tightening by suture were performed in all the keens. The clinical consequences were evaluated by comparison of knee function scores and imaging parameters before and after operation. [Results] All the 52 patients were successfully operated with operation time of(35.22±2.51) min on average, bed rest time of(1.52 ± 0.54) d, and hospital stay of(5.91 ±1.14) d. All of them had the incisions healed by first intention without serious complications. The 52 patients were followed up for 12 months at least. The anterior knee pain symptoms were obviously relieved in all patients after operation. The VAS score significantly decreased compared the data before operation with those at 3 month postoperatively and the latest follow-up(P<0.05). In term of knee function, the Lysholm score and Kujala score were also significantly improved compared the data before operation with those at 3 month postoperatively and the latest follow-up(P<0.05). In addition, patellofemoral fit angle, patellar inclination angle and patellar lateral displacement measured in images at 3 months after operation were statistically less than those before operation(P<0.05). [Conclusion] The lateral retinacular release combined with medial patellofemoral tightening by suture under arthroscopy is effective treatment for moderate patellofemoral arthritis.
[Objective] To evaluate the clinical outcomes of arthroscopic lateral retinacular release combined with medial patellofemoral tightening by suture for patellofemoral arthritis. [Methods] A total of 52 patients(64 knees) with patellofemoral arthritis were surgically treated in our department from January 2012 to December 2015. All the involved knees were graded as moderate and severe patellofemoral arthritis, failed to conservative treatment. The knee arthroscopic lateral retinacular release combined medial patellofemoral tightening by suture were performed in all the keens. The clinical consequences were evaluated by comparison of knee function scores and imaging parameters before and after operation. [Results] All the 52 patients were successfully operated with operation time of(35.22±2.51) min on average, bed rest time of(1.52 ± 0.54) d, and hospital stay of(5.91 ±1.14) d. All of them had the incisions healed by first intention without serious complications. The 52 patients were followed up for 12 months at least. The anterior knee pain symptoms were obviously relieved in all patients after operation. The VAS score significantly decreased compared the data before operation with those at 3 month postoperatively and the latest follow-up(P<0.05). In term of knee function, the Lysholm score and Kujala score were also significantly improved compared the data before operation with those at 3 month postoperatively and the latest follow-up(P<0.05). In addition, patellofemoral fit angle, patellar inclination angle and patellar lateral displacement measured in images at 3 months after operation were statistically less than those before operation(P<0.05). [Conclusion] The lateral retinacular release combined with medial patellofemoral tightening by suture under arthroscopy is effective treatment for moderate patellofemoral arthritis.
引文
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[10]王亮,叶如卿,陈先武,等.关节镜下髌骨成形、外侧支持带松解及髌周去神经化治疗中、重度髌股关节炎[J].中华创伤杂志,2017,33(8):743-749.
[11]赵建罡,高志国,马立学,等.膝关节镜下关节清理联合髌骨周围去神经化术治疗髌股关节炎膝前痛[J].中华创伤骨科杂志2015,17(2):180-182.
[12]申云龙,赵爱民,李建兵,等.外侧支持带松解术后髌骨轨迹的分析[J].中国矫形外科杂志,2016,24(13):1223-1227.
[13]李楠,侯雪玲,王少山.胫骨结节截骨前内侧移位术治疗髌股关节骨关节炎临床观察[J].中国中医骨伤科杂志,2016,24(3):21-25.
[2]林剑浩,杨艺,康晓征,等.中国内蒙古武川地区50岁以上中老年人髌股关节炎发病率及性别年龄分布特征研究[J].中华风湿病学杂志,2010,14(3):161-164.
[3]王亮,陈祁青,童培建,等.膝关节骨性关节炎早期诊断的临床特征分析[J].中国骨与关节损伤杂志,2015,30(2):161-163.
[4]Philippot R,Boyer B,Testa R,et al.The role of the medial ligamentous structures on patellar tracking during knee flexion[J].Knee Surg Sports Traumatol Arthrosc,2012,20(2):331-336.
[5]陈疾许,陈世益.髌股关节疾病研究进展[J].国外医学骨科学分册,2003,24(1):15-17.
[6]王亦进,郭新全,陈敬武,等.健康成人与老年骨性关节炎病人卧、立位膝关节内、外侧间隙宽度的测量研究[J].中国临床医学影像学杂志,2000,11(5):329-331.
[7]史晨辉,王永明,董金波,等.髌股关节骨性关节炎的病因探讨及关节镜诊治[J].中国矫形外科杂志,2003,11(22):67-69.
[8]余正红,蔡胥,赵卫东,等.膝关节神经分布的解剖学研究及其临床意义[J].中国临床解剖学杂志,2008,26(1):11-16.
[9]肇刚,刘玉杰,袁邦拓,等.关节镜下髌骨成形及髌周去神经化治疗髌股关节炎[J].中国骨伤杂志,2015,28(6):542-546.
[10]王亮,叶如卿,陈先武,等.关节镜下髌骨成形、外侧支持带松解及髌周去神经化治疗中、重度髌股关节炎[J].中华创伤杂志,2017,33(8):743-749.
[11]赵建罡,高志国,马立学,等.膝关节镜下关节清理联合髌骨周围去神经化术治疗髌股关节炎膝前痛[J].中华创伤骨科杂志2015,17(2):180-182.
[12]申云龙,赵爱民,李建兵,等.外侧支持带松解术后髌骨轨迹的分析[J].中国矫形外科杂志,2016,24(13):1223-1227.
[13]李楠,侯雪玲,王少山.胫骨结节截骨前内侧移位术治疗髌股关节骨关节炎临床观察[J].中国中医骨伤科杂志,2016,24(3):21-25.