摘要
目的探讨髌骨复发性脱位伴陈旧性骨软骨骨折的治疗方法及疗效。方法 2010年8月-2014年8月,收治12例髌骨复发性脱位伴陈旧性骨软骨骨折患者。其中男4例,女8例;年龄15~24岁,平均18.3岁。左膝7例,右膝5例。患者均有髌骨脱位史,伤后至该次就诊时间6~13个月,平均7.6个月。术前患侧膝关节活动度为（89.17±13.11）°,Lysholm评分为（56.67±18.91）分。Q角为（17.50±5.28）°,胫骨结节-股骨滑车（tibial tuberosity-trochlear groove,TT-TG）间距为（18.33±4.03）mm;其中6例Q角〉20°且TT-TG间距〉20 mm。髌骨关节面骨软骨骨折6例,股骨外髁骨软骨骨折5例,髌骨关节面合并股骨外髁骨软骨骨折1例。于关节镜下去除游离骨折块,其中2例行髌骨外侧支持带松解联合内侧支持带紧缩,4例行外侧支持带松解联合内侧支持带紧缩、内侧髌股韧带重建,6例行外侧支持带松解联合内侧支持带紧缩、内侧髌股韧带重建、胫骨结节移位。结果术后患者切口均Ⅰ期愈合,无感染、皮肤坏死、血肿形成等并发症发生。患者均获随访,随访时间12~60个月,平均24.2个月。术后3个月患者髌骨脱位纠正,6例行胫骨结节移位术者Q角为（13.33±1.37）°、TT-TG间距为（12.17±1.17）mm,与术前（22.50±2.17）°及（21.33±2.34）mm比较,差异均有统计学意义（t=15.25,P=0.00;t=8.27,P=0.00）。患者膝关节疼痛及交锁症状较术前明显缓解,末次随访时膝关节活动度为（120.42±11.57）°,Lysholm评分为（89.25±9.71）分,与术前比较差异均有统计学意义（t=—11.61,P=0.00;t=—8.66,P=0.00）。结论通过去除无法复位的陈旧骨软骨骨折块、矫正髌骨脱位治疗复发性髌骨脱位伴陈旧性骨软骨骨折,近期疗效满意。
Objective To explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. Methods Between August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years（range, 15-24 years）. The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months（range, 6-13 months）. At preoperation, the range of motion（ROM） of the injured knee was（89.17±13.11）°; the Lysholm score was 56.67±18.91; the Q-angle was（17.50±5.28）°; and tibial tuberosity-trochlear groove（TT-TG） distance was（18.33±4.03） mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament（MPFL） reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. Results All wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was（13.33±1.37）° and the TT-TG distance was（12.17±1.17） mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values [（22.50±2.17）° and（21.33±2.34） mm]（t=15.25, P=0.00; t=8.27, P=0.00）. All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were（120.42±11.57）° and 89.25±9.71, showing significant differences when compared with preoperative ones（t= —11.61, P=0.00; t= —8.66, P=0.00）. Conclusion It has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2016年第1期10-14,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
髌骨脱位
骨软骨骨折
膝关节
关节镜
Patellar dislocation
Osteochondral fracture
Knee
Arthroscope
