关节镜下治疗急性滑脱性髌股关节撞击综合症的临床研究.docVIP

关节镜下治疗急性滑脱性髌股关节撞击综合症的临床研究 马武强1 赵力2 李显3 1天津医科大学300070 2、3 天津市天津医院关节镜科 300211 【摘要】 目的 探讨急性滑脱性髌股关节撞击综合症的关节镜诊断、治疗与临床疗效。 方法 2010年2月至2013年7月收治并采用关节镜治疗急性滑脱性髌股关节撞击综合症35例，男11例，女24例。年龄13~27岁，平均19.6岁。左膝14例，右膝21例。所有患者均为外侧脱位。从受伤到手术时间间隔为4~27天，平均13.4天。术前对所有患者行影像学检查，观察髌骨的位置和形态、髌骨周围软组织损伤情况、股骨外髁及滑车的发育情况、下肢力线，测量Q角和检查全身关节松弛度。采用Lysholm评分评价术前与术后膝关节功能, Insall评分评价术后疗效。根据术前评估及术中关节镜检查情况采用不同术式：4例行关节镜下清理术加髌内侧支持带射频紧缩；9例行关节镜下清理加髌内侧支持带紧缩缝合术；22例行关节镜下清理加髌内侧支持带紧缩缝合及髌外侧支持带松解术。结果 35例患者均获得随访，随访时间25个月~42个月，平均28.2个月。随访期间内均未再次发生髌骨脱位。Lysholm评分，术后（94.2±3.6分）高于术前（57.4±3.8分）（P﹤0.05）。术后采用Insall评分，优18膝，良 15膝，可2膝，差0膝，优良率94.3﹪。结论 采用关节镜技术治疗急性滑脱性髌股关节撞击综合症具有创伤小、恢复快、操作方法简便，效果好等优点，值得在临床推广应用。 关键词 急性滑脱性髌股关节撞击综合症；关节镜；疗效 Arthroscopic treatment acute patellofemoral joint impingent syndrome Ma Wu qiang, Tianjin Medical University 300070 Zhao Li, Li Xian Department of Arthroscopic, Tianjin Hospital Corresponding author: Zhao Li 300211 【Abstract】 Objectivediagnosis ，treatment and clinical of acute patellofemoral joint impingent syndrome. Methods From February 2010 to July 2013, 35 patients with acute patellofemoral joint impingent syndrome were diagnosed and treated by arthroscopic, including 11 males and 24 females with an average age of 19.6 years (range, 13~27). Fourteen left keens and twenty-one right keens. All the patients were lateral dislocation. The average period after the dislocation to surgery was 13.4 days (range 4 to 27 days). Before operation , radiograph was used to determine the shape and the height of patella, the development situation of the femoral condyle , tackle and the axis of limb in each keen. Clinically Q angle and generalized joint laxity were measured. Lysholm scoring system to assess keen function before and after operation. Different surgical procedures were selected according to the type and the arthroscopic examinations. Four keens were done joint debridement and patellar retinaculum repair; nine keens done debridement and patella medical band suture; twenty-two keens were done debr