膝关节镜联合C型臂治疗复发性髌骨脱位疗效分析

摘要

Objective To investigate the effect of the arthroscopy combined with C-arm X-ray to treat recurrent dis-location of the patella.Methods From October 2013 to May 2017,58 cases(63 knees)with recurrent dislocation of the patella were admitted in our center,including 26 males(28 knees)and 32 females(35 knees)with an average age of 21.81 years old(range,16~47 years).We tried to explore and repair patellofemoral articular surface injury under arthroscopy, released the lateral patellofemoral,tibia tubercles transposition,with dual-bundle free autogenously semitendinosus u-sing two anchors(Smith&Nephew 3.5mm)to fix on the patella medial edge,with C-arm X-ray to reconstruct the Iso-metric point of the medial patellofemoral ligament and the 7 mm interference screw to fix on the femur.All patients were followed up for an average of 21 months(ranging 1~40).The imaging evaluation included Q angle,TT-TG,Insall-Salvati ratio,congruence angle,lateral patellofemoral angle and lateral shift.The clinical therapeutic effect was evaluated with International Knee Documentation Committee(IKDC),Lysholm.Results The fear test was negative after opera-tion,There was no redislocation and fracture of the patella during follow-up.The congruence angle,lateral patellofemo-ral angle and lateral shift were(0.20±4.19)°,(3.52±1.33)°and(0.35±0.14)respectively at the final follow-up.The mean IKDC and Lysholm were(87.46±4.04)and(87.28±3.33)respectively at the final follow-up.And they were statis-tically different between the value before and after operation(P<0.05).Conclusion There is a reliable short-term effect to treat recurrent patella dislocation by the arthroscopy combined with C-arm X-ray to reconstruct the Isometric point of the medial patellofemoral ligament.%目的 探讨膝关节镜联合C型臂透视下定位重建内侧髌股韧带等长点治疗复发性髌骨脱位的疗效.方法自2013年10月至2017年5月收治复发性髌骨脱位58例(63膝),男26例28膝,女32例35膝;年龄16~47岁,平均(21.8±7.16)岁.采用膝关节镜联合C臂机透视下定位内侧髌股韧带等长点,自体半腱肌肌腱移植双束解剖重建内侧髌股韧带治疗.对其进行影像学评价:Q角、胫骨结节股骨滑车沟(tibia tuberosity-trochlear groove,TT-TG), Insall-Salvati指数、髌股适合角、外侧髌股角、髌骨外移率;临床疗效评价包括国际膝关节评分委员会(International Knee Documentation Committee,IKDC)膝关节功能主观评分、Lysholm膝关节功能评分.结果 所有病例均获得随访,随访时间1~40个月,平均21个月.术后恐惧试验均阴性,随访期间无髌骨再脱位及骨折发生.末次随访时髌股适合角(0.20±4.19)°,外侧髌股角(3.52±1.33)°,髌骨外移率(0.35±0.14).与术前比较差异有统计学意义(P<0.05);IKDC膝关节功能主观评分(87.46±4.04)分、Lysholm膝关节功能评分(87.28±3.33)分,与术前比较差异有统计学意义(P<0.05).结论 膝关节镜联合"C"型臂透视下定位重建内侧髌股韧带等长点治疗复发性髌骨脱位的近期效果可靠.