摘要
目的探讨关节镜下应用双极射频治疗髌股关节对合不良的技术及其早期疗效。方法42例(47膝)经X线检查证实有髌股关节对合不良的膝前痛患者接受关节镜下应用双极射频进行的软骨成形术和外侧支持带松解术。术中采用Outerbridge分级法对软骨病变进行分级。术后37个膝获得随访,平均随访18.3个月。手术前后采用Kujala髌股关节评分法比较髌股关节功能恢复情况,并通过MRI测量23个膝关节的髌股关节软骨面的对合角度。结果软骨病变OuterbridgeⅠ级的6膝,手术前后髌股关节评分为60.83±3.54和82.50±9.22,差异有统计学意义(P<0.001);Ⅱ级的13膝手术前后评分为61.77±8.40和79.69±10.47,差异有统计学意义(P<0.001);Ⅲ级的11膝手术前后评分为53.27±7.42和61.09±7.58,差异有统计学意义(P<0.05);Ⅳ级的7膝手术前后评分为47.29±5.79和52.14±8.30,差异无统计学意义(P>0.05)。手术前后总的评分55.86±9.39和69.41±14.89,髌股关节功能明显改善(P<0.001)。手术前后MRI对比:软骨性倾斜角(Tac)为14.07°±3.30°和11.71°±2.29°,软骨性适合角(Cac)为18.51°±10.61°和13.31°±9.17°,软骨性外侧髌股角(LPFac)为8.50°±1.94°和13.59°±2.48°,软骨性外侧移动度(LPDc)为(4.29±2.36)mm和(1.75±1.56)mm,这四项指标差异均有统计学意义(P<0.001)。结论针对不同退变程度的软骨应用适当的双极射频技术,结合关节镜下外侧支持带松解术,可以有效恢复软骨面的平整性并改善髌股关节的对合,从而改进髌股关节的功能。
Objective To study the early effect of arthroseopie bipolar radiofrequeney teehnique in the treatment of patellofemoral malalignment. Methods 42 patients （47 knees） who were eonfirmed to be patellofemoral malalignment hv radiographic＇ methods, underwent arthroseopie bipolar radiofrequeney ehondroplasly and lateral retinacular release. The cartilage abnormality were classified according to the Outerbridge grade. 34 cases（37 knees） were follwed up and mean period was 18.3 months. Patients were assessed before and after surgery using the Kujala patellofemoral score. Patellofemoral alignment were evaluated through MRI in 23 of 37 knees. The change of Cae （congruence angle of cartilage）, Tac（tih angle of carti- lage）,LPDe （lateral patellofemoral distance of cartilage） and LPFae（laleral patellofemoral angle of cartilage） were measured. Results The patellofemoral joint score was improved significantly in Outerbridge Ⅰ, Ⅱ and m grade patients （6 knees of Ⅰ grade： 60.83±3.54 preoperatively and 82.50±9.22 postoperatively, P〈0.001 ; 13 knees of Ⅱ grade： 61.77±8.40 preoperatively and 79.69±10.47 postoperatively, P〈 0.001 ;11 knees of Ⅲ grade： 53.27±7.42 preoperatively and 61.09±7.58 pnstoperatively, P〈 0.05）, while there was no change significantly in 7 knees of Outerhridge Ⅳ grade patients（47.29±5.79 preoperatively and 52.14±8.30 postoperatively, P 〉0.05）. The score of all these 37 knees was improved from 55.86±9.39 preoperatively to 69.41±14.89 pnstoperatively （ P〈 0.001 ）. Cae changed from 18.51°±10.61° preoperatively to 13.31°±9.17° postoperatively, Tae changed from 14.07°±3.30° to 11.71°±2.29°, LPDe changed from （4.29±2.36） mm to （1.75±1.56） mm and LPFae increased from 8.50°±1.94°to 13.59°±2.48°. All of these four criteria were changed signifieantly （P〈 0.001）. Conclusion Using appropriate arthroseopic biporlar radiofrequeney technique combined with lateral retinaeular release eouhl smooth the articular cartilage surface and improve alignment effectively. The patients would achieve better patellofemoral joint function.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2005年第11期641-646,共6页
Chinese Journal of Orthopaedics
关键词
关节镜检查
髌股疼痛综合征
软骨
关节
Arthroscopy
Patellofemoral pain syndrome
Cartilage, articular
