摘要
目的 :探讨关节镜下外侧支持带松解治疗髌骨外侧高压综合征的效果和临床意义。方法 :采用关节镜下外侧支持带松解术治疗 39例 (5 1膝 )髌骨外侧高压综合征。男 1例 (1膝 ) ,女 38例 (5 0膝 ) ;单膝 2 7例 ,双膝 12例 ;平均年龄 4 9 6岁 (2 8～ 71岁 )。临床症状以髌股关节钝痛为特点 ,疼痛位置不易确定 ,髌股关节负荷过度的活动会使疼痛加重。物理检查见Q角增大 (>2 0°) 4 5膝 ,髌软骨外侧小面抠触痛 5 0膝 ,外侧支持带压痛 39膝 ,被动髌骨倾斜试验阳性 5 1膝 ,内外侧滑动试验阳性 4 9膝 ,压髌试验阳性 5 1膝。X线检查轴位片见髌股对合角异常 32膝。术中在关节镜监视下 ,用射频汽化钩刀松解外侧支持带 ,必要时可向近端扩大松解范围 ,切断部分股外侧肌 ,达到完全松解。结果 :术后所有病例均得到随访 ,平均随访 14 5个月 (3～ 2 6个月 )。疗效评定参照改良Lysholm评分标准 ,优 37膝 ,良 12膝 ,可2膝。Lysholm评分从术前平均 (6 2 0 4± 5 98)分 (4 9～ 75分 )提高到术后平均 (93 71± 3 5 5 )分 (86～10 0分 ) ,有显著性差异 (t=6 6 3,P <0 0 0 1)。髌股对合角异常的 32膝中术后有 30膝髌股对合角恢复正常 (94 % )。术后 5膝有血肿形成 (10 % )。结论 :关节镜下外侧支持带松解是一种微创的软组织平?
Objective:To explore the practical significance and effects of arthroscopic lateral retinacular release in the treatment of symptomatic lateral patellar compression syndrome.Methods:Thirty-nine patients (fifty-one knees) with lateral patellar compression syndrome underwent arthroscopic lateral retinacular release.The patients were comprised of one man (one knee) and thirty-eight women (fifty knees).One knee was affected in twenty-seven patients,and double knees in twelve patients.Mean age 49.6 years (ranging from twenty-eight to seventy-one years).The clinical symptoms were characteristically dull pain,poorly localized,and increased by activities that overload the patellofemoral joint.In physical examination,we found Q angle increased (>20°) in forty-five knees,the lateral patella facet was tender in fifty knees,the lateral retinaculum was tender in thirty-nine knees,passive patellar tilt test positive in fifty-one knees,medial and lateral glide test positive in forty-nine knees,patellar compression test positive in fifty-one knees.Using axial views we found the congruence angle abnormal in thirty-two knees.Under arthroscopic guidance the lateral retinaculum was released with radiofrequency vaporization,if it is required,we enlarged the range of releasing proximally toward the vastus lateralis for complete releasing.Results:All the patients were available at following-up,the mean following-up was 14.5 months (ranging from three to twenty-six months).The results were evaluated according to the modified Lysholm scoring system,exellent in thirty-seven knees,good in twelve knees and fair in two knees.The mean preoperative Lysholm score increased from 62.04 (ranging from forty-nine to seventy-five) to 93.71 (range eighty-six to one hundred) postoperatively,the difference was statistically significant (t=6.63,P<0.001).Preoperative and postoperative congruence angles were compared on the tangential patella roentgenograms,the congruence angle recoverd to normal postoperatively in thirty-two knees (94%).Five knees developed hemarthrosis postoperatively (10%).Conclusion:Arthroscopic lateral release is a soft-tissue balancing technique and may provide a successful outcome with a low incidence of complication when used to treat patellofemoral pain due to lateral patellar compression syndrome.
出处
《中国骨伤》
CAS
2004年第8期458-460,共3页
China Journal of Orthopaedics and Traumatology
关键词
髌骨
关节镜下
松解治疗
综合征
术后
髌股关节
疼痛
支持
扩大
平均
Arthroscopic surgical procedures
Lateral retinacular release
Lateral patellar compression syndrome
